| NPI | 1205641925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA LANEE GREEN-BOYD Administrator 813-999-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-02-10 |