| NPI | 1053712125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDA L. MOORE CEO 904-759-5089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103TP0016X Psychologist Prescribing (Medical) |
| 363LP2300X Nurse Practitioner Primary Care | |
| 364SH0200X Clinical Nurse Specialist Home Health | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2014-09-09 |