Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 415 | SC |
N | 103T00000X | Psychologist | 415 | SC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 415 | SC |
N | 103TC1900X | Counseling Psychologist | 415 | SC |
NPI | 1124120225 |
---|---|
Provider Name | Dr. Michael Anthony Kollar |
First Address | Charleston, SC 29407 |
Second Address | Charleston, SC 29407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |