| NPI | 1245881366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IMMACULA SAINT LOUIS Medical Director 843-879-4763 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2022-06-07 |