Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 260946 | SC |
NPI | 1083045066 |
---|---|
Provider Name | Philip Young |
First Address | Aiken, SC 29803-2109 |
Second Address | Aiken, SC 29803-2109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2013 |
Last Update Date | 02/12/2013 |