| NPI | 1184300436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE WALLENS Accounting Manager 386-449-7805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-11-08 |