| NPI | 1073762415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J PHYLLIS BRANNEN President 321-953-3225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW6239) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2553L) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2008-09-10 |