Provider Demographics
NPI:1326087149
Name:TIMMONS, DAPHNE JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:JANE
Last Name:TIMMONS
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 1:114 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1249
Mailing Address - Country:US
Mailing Address - Phone:843-805-8001
Mailing Address - Fax:843-805-8070
Practice Address - Street 1:114 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1249
Practice Address - Country:US
Practice Address - Phone:843-805-8001
Practice Address - Fax:843-805-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1633164OtherUNITED BEHAVIORAL HEALTH
NC6000262Medicaid
NC1001633164002OtherUNITED HEALTHCARE
NC04708OtherBCBS OF NC
SCPS0454Medicaid
SCPS0454Medicaid
NC1001633164002OtherUNITED HEALTHCARE
NC1633164OtherUNITED BEHAVIORAL HEALTH