| NPI | 1053681205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN K DAHL Owner 904-241-3113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL ND546) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: FL nd546) |
| 101YM0800X Counselor, Mental Health (Licence: FL mh8334) | |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2015-08-07 |