| NPI | 1285001560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY L NICHOLSON Psychologist 843-226-6690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1340) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |