| NPI | 1699406363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS THOMPSON Chief Executive Officer 843-619-8872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2022-06-22 |