| NPI | 1225304546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANGELA K CRISWELL Business Office Director 843-663-8017 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 3657) |
| 104100000X Social Worker (Licence: SC 7136) | |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2012-03-30 |