| NPI | 1043774078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLI ODUM Clinical Therapist 407-801-9628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |