| NPI | 1205231404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE L WILSON Provider & Owner 561-308-0814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12108) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2014-10-30 |