| NPI | 1740630045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA L JUDD Sole Proprietor 864-504-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 0069) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2016-08-10 |