| NPI | 1689038325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY WALLACE REDFEARN Owner 843-917-0495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 4605) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2016-04-08 |