Provider Demographics
NPI:1457568107
Name:CLINICAL ASSOCIATES OF HILTON HEAD,P.C
Entity Type:Organization
Organization Name:CLINICAL ASSOCIATES OF HILTON HEAD,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:V
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-842-5526
Mailing Address - Street 1:21 OFFICE PARK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4654
Mailing Address - Country:US
Mailing Address - Phone:843-842-5526
Mailing Address - Fax:843-842-4764
Practice Address - Street 1:21 OFFICE PARK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4654
Practice Address - Country:US
Practice Address - Phone:843-842-5526
Practice Address - Fax:843-842-4764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC#283103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1154352920OtherINDIVIDUAL