| NPI | 1124851118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN S. WILKS-YOUNG Clinical Director/CEO 772-577-0405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-08-23 |
| Last Update Date | 2024-08-23 |