| NPI | 1053917922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE JEAN Licensed Clinical Social Worker 352-234-3208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |