Organization
JOURNEY REVEALED
Active
Organization
JOURNEY REVEALED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURI MAZE-DAVIS APRN (MANAGER)
(803) 431-0734
Entity
Organization
Contact information
Practice address
1700 FIRST BAXTER XING, SUITE 204, FORT MILL, SC 29708-8948
(803) 431-0734
Mailing address
44429 ORIOLE DR, UNIT 101, INDIAN LAND, SC 29707-5947
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
—
—
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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