| NPI | 1073029252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA JO FULLER Mental Health Counselor 407-716-7668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL L13000079124) |
| Enumeration Date | 2017-12-25 |
| Last Update Date | 2017-12-25 |