Provider Demographics
NPI:1376772335
Name:SEASONS PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SEASONS PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:ANDREA LEA PRITCHARD-BOONE, PH. D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:PRITCHARD-BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-407-4440
Mailing Address - Street 1:314 S MCQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4723
Mailing Address - Country:US
Mailing Address - Phone:843-407-4440
Mailing Address - Fax:843-407-4461
Practice Address - Street 1:314 S MCQUEEN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4723
Practice Address - Country:US
Practice Address - Phone:843-407-4440
Practice Address - Fax:843-407-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1122103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5420Medicaid
SCGP5420Medicaid