| NPI | 1093710303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JEASONNE Grant And Contract Manger 772-210-0156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 15-43-AD-0899-00) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical | |
| 251B00000X Case Management | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9469081) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2024-03-13 |