Organization
LETS MAKE A DIFFERENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIA GRAVES LISW (EXECUTIVE DIRECTOR)
(843) 627-1012
Entity
Organization
Contact information
Practice address
1409 HIGHWAY 301 N, DILLON, SC 29536-2165
(842) 627-1012
(843) 627-0101
Mailing address
PO BOX 2104, DILLON, SC 29536-7104
(842) 627-1012
(843) 627-0101
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6377
SC
Other
Enumeration date
01/20/2012
Last updated
01/27/2012
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