| NPI | 1104607258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL ANTWANETTE KINGCADE Nurse Practitioner 843-676-5461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |