| NPI | 1154762284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY WALLACE CEO 904-534-4937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2025-11-17 |