| NPI | 1942666839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTI HERNDON Office Manager 803-649-0808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: SC 14838) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2016-01-07 |