| NPI | 1801660477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELENA LEDFORD Director, Practice Operations 843-868-2005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2024-04-15 |