| NPI | 1134664139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA ANN RUTLEDGE-CAPERS Owner 850-292-2769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: FL MN7826) |
| Additional Taxonomies | 261Q00000X (Licence: GA MH7826) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2018-06-20 |