| NPI | 1124512132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE JOHNSON Clinical Director 803-851-4049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 5155) |
| Additional Taxonomies | 251S00000X (Licence: SC 5155) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: SC 5155) | |
| 251B00000X Case Management (Licence: SC 5155) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: SC 5155) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: SC 5155) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |