| NPI | 1003324211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKI LYNN NODURFT-LUCK Clinical Social Worker 352-682-2209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 9742) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2018-04-15 |