| NPI | 1790067973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD WITHERSPOON Director 843-452-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC LIC-5-11-62510) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-19 |