| NPI | 1023697745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LANE STEVENS Owner 904-294-6277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 106H00000X Marriage & Family Therapist | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-03-24 |