| NPI | 1124783477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA DALE CFO 904-387-4661 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2022-05-13 |