Provider Demographics
NPI:1285648105
Name:HARBISON PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:HARBISON PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-749-6620
Mailing Address - Street 1:1 HARBISON WAY
Mailing Address - Street 2:SUITE 229
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3422
Mailing Address - Country:US
Mailing Address - Phone:809-749-6620
Mailing Address - Fax:803-407-6905
Practice Address - Street 1:1 HARBISON WAY
Practice Address - Street 2:SUITE 229
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3422
Practice Address - Country:US
Practice Address - Phone:809-749-6620
Practice Address - Fax:803-407-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC809103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4395Medicaid
SCPS0336Medicaid
SCGP4410Medicaid