| NPI | 1548874621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANSAS GOLLER Counselor 843-441-2317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-12-31 |