| NPI | 1134848146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TILLARY TICE Owner 904-853-0564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |