| NPI | 1114489317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVIN COLCLOUGH Owner/Clinical Director 803-795-8604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2019-05-29 |