| NPI | 1053149351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA SHERROUSE Owner 850-373-8002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-12-11 |