| NPI | 1164827838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA ANNE DIVICO Owner 813-384-4215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11494) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2023-07-28 |