| NPI | 1144793118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY S WELLS CEO 904-566-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2019-03-20 |