Dutch Fork Psychological Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

654 Issued in SC

Legal business name

DUTCH FORK PSYCHOLOGICAL SERVICES

Practice address

7313 College St
Irmo, SC 29063-2902

Phone

(803) 407-7099

Fax

(803) 807-9104

NPI assigned

Jul 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William E. Haxton, PH.D.

Title

Owner

Phone

(803) 407-7099

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1750308409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7313 COLLEGE ST",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632902",
            "telephone_number": "803-407-7099",
            "fax_number": "803-807-9104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7313 COLLEGE ST",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632902",
            "telephone_number": "803-407-7099",
            "fax_number": "803-807-9104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUTCH FORK PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "HAXTON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-407-7099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4164",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lora L. Dunn, LMBT, NCTMB
• Lense Tessema Duresso, MD
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• Cynthia Dianne Edsel
• Nicole Sovde Edwards, MSP. CCC-SLP
• Elizabeth Lois Elijah
• Nina S Ellison, FNP

• All providers in Irmo, SC
• Clinical Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.