| NPI | 1013504539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI KENNEDY Clinical Director 843-225-7884 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2021-01-15 |