| NPI | 1164155974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH TISH DE MEDICI Credentialing Mgr 904-376-3800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-08 |