| NPI | 1215509005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMARIS REVERON Office Manager 352-988-6673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |