Organization
EXCHANGE CLUB CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATANYA FISHER (PROGRAM DIRECTOR)
(843) 747-1339
Entity
Organization
Contact information
Practice address
1092 E MONTAGUE AVE, NORTH CHARLESTON, SC 29405-4837
(843) 747-1339
Mailing address
1092 E MONTAGUE AVE, NORTH CHARLESTON, SC 29405-4837
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MC0064
—
SC
Enumeration date
06/22/2007
Last updated
08/22/2020
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