| NPI | 1609366699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY LEE FORTNER President Owner 843-240-9446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2020-07-22 |