Provider Demographics
NPI:1336156256
Name:MCLEOD, PHOEBE A (PHD)
Entity type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:A
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205
Mailing Address - Country:US
Mailing Address - Phone:803-799-0004
Mailing Address - Fax:803-799-0004
Practice Address - Street 1:2212 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205
Practice Address - Country:US
Practice Address - Phone:803-799-0004
Practice Address - Fax:803-799-0004
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical