| NPI | 1245601020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LYNNE LOVE Licensed Clinical Social Worker 850-274-7299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 1031) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 13189) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2017-01-18 |