| NPI | 1255764064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNDON EUGENE COWHERD Owner 813-262-0471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH 0002343) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |