| NPI | 1205462504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB A WIDDEKIND Manager 954-369-0570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2020-03-18 |