| NPI | 1083342109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEITHA BAKER Credentialing Supervisor 954-262-9416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist, Counseling | |
| 103TF0000X Psychologist, Family | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2025-08-27 |