| NPI | 1023615846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO LAMAR WYCHE Co Owner 850-692-9268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-05 |