| NPI | 1114426400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FULLER Owner 407-716-7669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2018-02-02 |