| NPI | 1699179564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY MICHELLE RENTERIA' Owner/Operator 843-816-1815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5680) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: SC 5680) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2014-10-21 |