| NPI | 1093041154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA P JACK Mental Health Counselor 407-623-1070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH8933) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2009-10-26 |