| NPI | 1902212251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVA JANE GIBEAU Np 843-779-4254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: SC APN1620) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2014-07-08 |