Provider Demographics
NPI:1639517774
Name:O'HARA, MARIE MURRAY (PHD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MURRAY
Last Name:O'HARA
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 1:400 COLLEGE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2925
Mailing Address - Country:US
Mailing Address - Phone:864-903-2414
Mailing Address - Fax:
Practice Address - Street 1:400 COLLEGE AVE STE 4
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2925
Practice Address - Country:US
Practice Address - Phone:864-903-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist