| NPI | 1750501219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM PAUL CARLSON Director 803-606-1123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC LPC # 22) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-05-21 |