| NPI | 1033764071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA SAMAKE President/Pmhnp 864-990-5664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2023-10-11 |