| NPI | 1982107959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE PETERSON Clinical Psychologist 803-779-3548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1271) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2018-03-15 |