| NPI | 1134943848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADALYN DERRICK Owner 407-803-2390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-11-09 |
| Last Update Date | 2024-11-09 |