Organization
BLUEPRINT FOR CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE SINGLETON TABOR CACII, LICDC (ADMINISTRATIVE DIRECTOR)
(843) 524-6112
Entity
Organization
Contact information
Practice address
1110 PARIS AVE STE A, PORT ROYAL, SC 29935-2322
(843) 524-6112
(843) 524-6111
Mailing address
1110 PARIS AVE STE A, PORT ROYAL, SC 29935-2322
(843) 524-6112
(843) 524-6111
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/11/2008
Last updated
01/11/2008
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