Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103TC1900X | Counseling Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1275923484 |
---|---|
Provider Name | Jonathan Murdaugh |
First Address | Fairfax, SC 29827-1332 |
Second Address | Fairfax, SC 29827-7220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2015 |
Last Update Date | 28/01/2015 |