Provider Demographics
NPI:1336680438
Name:CHARLESTON PEDIATRIC PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:CHARLESTON PEDIATRIC PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:G
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:843-801-0135
Mailing Address - Street 1:222 W COLEMAN BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3588
Mailing Address - Country:US
Mailing Address - Phone:843-801-0135
Mailing Address - Fax:
Practice Address - Street 1:222 W COLEMAN BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3588
Practice Address - Country:US
Practice Address - Phone:843-801-0135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1433103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty