| NPI | 1023396934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNE LYNN DEPEW Office Manager 386-428-4564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH5611) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-07-26 |