Organization
GODLY AMBITION OF NEW GENERATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANN G LESANE MA, AS (PROGRAM DIRECTOR)
(843) 621-2696
Entity
Organization
Contact information
Practice address
3501 E WINLARK DR, FLORENCE, SC 29506-8637
(843) 621-2696
Mailing address
3501 E WINLARK DR, FLORENCE, SC 29506-8637
(843) 621-2696
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
1042065
SC
Other
Enumeration date
06/03/2014
Last updated
06/03/2014
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