Provider Demographics
NPI:1336660315
Name:CHARLESTON NEUROPSYCHOLOGY LLC
Entity Type:Organization
Organization Name:CHARLESTON NEUROPSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:TEICHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-849-9913
Mailing Address - Street 1:1459 STUART ENGALS BLVD.,
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-849-9913
Mailing Address - Fax:843-881-6878
Practice Address - Street 1:1459 STUART ENGALS BLVD.,
Practice Address - Street 2:SUITE 204A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-849-9913
Practice Address - Fax:843-881-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty