| NPI | 1215906649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA WAGNER Administrator 904-376-3800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-09-10 |