| NPI | 1538361746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A BENNICE Licensed Clinical Psychologist 843-330-8663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: SC 985) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-08-22 |