| NPI | 1215321963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA HICKENBOTHAM Mental Health Counselor 850-226-7226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11935) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-03-19 |