Organization
DUTCH FORK PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM E. HAXTON PH.D. (OWNER)
(803) 407-7099
Entity
Organization
Contact information
Practice address
7313 COLLEGE ST, IRMO, SC 29063-2902
(803) 407-7099
(803) 807-9104
Mailing address
7313 COLLEGE ST, IRMO, SC 29063-2902
(803) 407-7099
(803) 807-9104
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
654
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4164
—
SC
Enumeration date
07/17/2006
Last updated
04/27/2015
Update your record
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