| NPI | 1164042644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GRUER SULLIVAN Owner/Operator 863-410-2095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2020-04-24 |