| NPI | 1104479971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL A WILSON Billing Administrator 864-878-1528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2022-12-20 |