Provider Demographics
NPI:1184679169
Name:KILROY, VALERIE R (PHD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:R
Last Name:KILROY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3781
Mailing Address - Country:US
Mailing Address - Phone:843-676-3420
Mailing Address - Fax:843-292-9810
Practice Address - Street 1:901 S SANTIAGO DR
Practice Address - Street 2:SUITE M
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6091
Practice Address - Country:US
Practice Address - Phone:843-676-3420
Practice Address - Fax:843-292-9810
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPSO325Medicaid