| NPI | 1972181642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNDELE LANIK DANZY Authorized Official/ Member 803-518-9079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-07-05 |