| NPI | 1154892099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM J GILMORE Co Owner 803-497-9611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2020-07-15 |