| NPI | 1023697745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LANE STEVENS Owner 904-294-6277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-02-23 |