| NPI | 1083815674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN TUCKER Clinical Counselor 803-796-0353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 01858 600) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-08-07 |