| NPI | 1083144125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANA LENETTE TUCKER Clincial Counselor 803-727-0658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 6111) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2019-06-11 |