Individual
DR. KENNETH W PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, LMFT
Contact information
Practice address
3555 HARDEN STREET EXT, 15 MEDICAL PARK, SUITE 141, COLUMBIA, SC 29203-6894
(803) 434-4221
(803) 434-4351
Mailing address
3555 HARDEN STREET EXT, 15 MEDICAL PARK, SUITE 141, COLUMBIA, SC 29203-6894
(803) 434-4221
(803) 434-4351
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
1309
NC
106H00000X
Marriage & Family Therapist
Primary
4520
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LT1001
—
SC
Enumeration date
07/07/2009
Last updated
11/12/2010
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