Provider Demographics
NPI:1114148533
Name:PHOEBE A. MCLEOD, PH.D.
Entity Type:Organization
Organization Name:PHOEBE A. MCLEOD, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:ALISSA
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-799-0004
Mailing Address - Street 1:2212 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2402
Mailing Address - Country:US
Mailing Address - Phone:803-799-0004
Mailing Address - Fax:803-799-0004
Practice Address - Street 1:2212 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2402
Practice Address - Country:US
Practice Address - Phone:803-799-0004
Practice Address - Fax:803-799-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty