| NPI | 1013224989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDMOND RUSSELL BAXLEY CEO 843-522-5140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: SC 6685) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2019-11-06 |