| NPI | 1235593237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOTT RICHELSON President, Treasurer 904-605-4986 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 207Q00000X Family Medicine | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-02-24 |