| NPI | 1407326135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY F JACKSON Owner 843-259-6535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |