Organization
1 FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIJAH HAMPTON (CEO)
(773) 946-0995
Entity
Organization
Contact information
Practice address
150 BW THOMAS DR, FORT MILL, SC 29708-7230
(773) 946-0995
Mailing address
9904 BONITA LN APT 411, CHARLOTTE, NC 28262-1078
(773) 946-0995
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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