| NPI | 1013572304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA KAY EVANS Administrator 904-379-7359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2019-05-02 |