| NPI | 1255606158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GLOCK Owner 904-260-0218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT604) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2012-03-13 |