| NPI | 1003621251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKLYN LOVE RODDENBERRY Owner 850-519-3928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-08-13 |