Provider Demographics
NPI:1225308448
Name:MURPHY, THELVANESA (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:THELVANESA
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 SMALLWOOD RD
Mailing Address - Street 2:UNIT 202
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3232
Mailing Address - Country:US
Mailing Address - Phone:803-708-4532
Mailing Address - Fax:
Practice Address - Street 1:4824 SMALLWOOD RD
Practice Address - Street 2:UNIT 202
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-3232
Practice Address - Country:US
Practice Address - Phone:803-708-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4585103TM1800X, 103TS0200X, 103TB0200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy