| NPI | 1003774555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIERAINIE C JOHNSON Owner 904-944-1269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2026-01-13 |
| Last Update Date | 2026-01-13 |