| NPI | 1063274041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS SISOFO Physician Assistant 843-900-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-04-30 |