Provider Demographics
NPI:1215454079
Name:CLONINGER, MARJORIE G (PHD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:G
Last Name:CLONINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:GREFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-293-7320
Mailing Address - Fax:803-293-7330
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-346-5984
Practice Address - Fax:803-434-1920
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist