Provider Demographics
NPI:1699836627
Name:CAROLINA PSYCHOLOGICAL RESOURCES
Entity Type:Organization
Organization Name:CAROLINA PSYCHOLOGICAL RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-252-4935
Mailing Address - Street 1:703 KAWANA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2030
Mailing Address - Country:US
Mailing Address - Phone:803-254-0782
Mailing Address - Fax:
Practice Address - Street 1:1620 LADY ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3404
Practice Address - Country:US
Practice Address - Phone:803-252-4935
Practice Address - Fax:803-252-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2672Medicare ID - Type Unspecified