Organization
THE CALVARY EXPERIENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA WILLIAMS (OWNER)
(843) 834-6038
Entity
Organization
Contact information
Practice address
2810 ASHLEY PHOSPHATE RD STE B8, N CHARLESTON, SC 29418-6406
(843) 297-4630
Mailing address
2810 ASHLEY PHOSPHATE RD STE B8, N CHARLESTON, SC 29418-6406
(843) 297-4630
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801452925
—
SC
Enumeration date
06/21/2019
Last updated
06/21/2019
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