| NPI | 1063043420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY PACKIAM ALLOWAY Licensed Psychologist 904-860-4813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2020-02-09 |