| NPI | 1043817786 |
|---|---|
| Former Legal Business Name | ANTIDOTE WELLNESS LLC |
| Entity Type | Organization |
| Authorized Contact | AMANDA L HAGGARD Sole Owner/Psychotherapist 850-332-3087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |