# LANTANA PSYCHIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366013823
- **Authorized official:** MR. CARL DOMINIC ROSA (BOARD MEMBER)
- **Authorized official phone:** (203) 910-4144

## Contact information

- **Practice address:** 1470 BEN SAWYER BLVD STE 6, MT PLEASANT, SC 29464-4593
- **Practice address phone:** (843) 352-9982
- **Mailing address:** 1470 BEN SAWYER BLVD STE 6, MT PLEASANT, SC 29464-4593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2021
- **Last updated:** 07/06/2021