| NPI | 1972845196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARY POOLE Behavioral Consultant 843-513-0040 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: SC 1-13-12976) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: SC 1-13-12976) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2013-03-26 |