| NPI | 1053104828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELECIA NICOLENE SMIKLE Provider/Owner 803-448-0205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-05-26 |
| Last Update Date | 2025-06-04 |