| NPI | 1154175917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONIA AMBUSH Licensed Mental Health Counselor 850-361-8421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-04-17 |