| NPI | 1457522658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ROBERT NEBOSCHICK Licensed Psychologist 843-852-9016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: SC 328) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: SC 328) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |