Provider Demographics
NPI:1346451069
Name:KILLEEN, THERESE KATHLEEN (PHD APRN)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:KATHLEEN
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:PHD APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5736
Mailing Address - Country:US
Mailing Address - Phone:843-792-5232
Mailing Address - Fax:843-792-8206
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 190
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-792-5232
Practice Address - Fax:843-792-8206
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13030364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health