| NPI | 1215490099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA DIXON Owner 727-557-7941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |