| NPI | 1083225221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHTON SULLIVAN Owner 843-941-3482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2020-08-12 |