| NPI | 1104218635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE SULLIVAN Therapist 843-345-5121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 5739) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2015-02-20 |