Organization
CAROLINA DEVELOPMENTAL CLINIC, LLC
Active
Organization
CAROLINA DEVELOPMENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY DEANNE BRIGMAN M.D. (OWNER AND MEDICAL DIRECTOR)
(803) 957-5856
Entity
Organization
Contact information
Practice address
107 VISTA OAKS DR STE C, LEXINGTON, SC 29072-8230
(803) 957-5856
(803) 957-5856
Mailing address
107 VISTA OAKS DR STE C, LEXINGTON, SC 29072-8230
(803) 957-5856
(803) 957-5856
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
23497
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234972
—
SC
Enumeration date
09/17/2010
Last updated
09/17/2010
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