Organization
LANTANA PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL DOMINIC ROSA (BOARD MEMBER)
(203) 910-4144
Entity
Organization
Contact information
Practice address
1470 BEN SAWYER BLVD STE 6, MT PLEASANT, SC 29464-4593
(843) 352-9982
Mailing address
1470 BEN SAWYER BLVD STE 6, MT PLEASANT, SC 29464-4593
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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