| NPI | 1639210008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDR MICHAEL FEDERER Licensed Clinical Psychologist 843-673-0727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 569) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-08-22 |