| NPI | 1053821819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M ESCUDIE Manage 813-546-4027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11422) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2017-10-06 |