| NPI | 1205675329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANITHA NICHOLAS Owner 904-208-0760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |