| NPI | 1033970140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA SMITH Office Manager 772-812-1897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2025-02-28 |