Provider Demographics
NPI:1710120233
Name:O'LEARY, WILLIAM COLDEN JR (PH D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COLDEN
Last Name:O'LEARY
Suffix:JR
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 8052
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29861
Mailing Address - Country:US
Mailing Address - Phone:706-755-6211
Mailing Address - Fax:
Practice Address - Street 1:4988 HEREFORD FARM RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-6006
Practice Address - Country:US
Practice Address - Phone:706-860-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC177103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling