| NPI | 1124598669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CORDDRY Owner 407-622-8086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2022-11-09 |