| NPI | 1083161392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA POWELL DUBOSE Licensed Clinical Social Worker 850-748-1647 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL SW4505) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-02 |