Provider Demographics
NPI:1942644091
Name:PSYCHOLOGY SERVICES CENTER
Entity Type:Organization
Organization Name:PSYCHOLOGY SERVICES CENTER
Other - Org Name:UNIVERSITY OF SOUTH CAROLINA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-734-0378
Mailing Address - Street 1:2221 DEVINE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2418
Mailing Address - Country:US
Mailing Address - Phone:803-734-0378
Mailing Address - Fax:803-734-0379
Practice Address - Street 1:2221 DEVINE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2418
Practice Address - Country:US
Practice Address - Phone:803-734-0378
Practice Address - Fax:803-734-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty