| NPI | 1023392305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL BLACKSTON President/Mental Health Counselor 407-405-7677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: FL MH9621) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |