| NPI | 1265737076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BROOK WATTS Counselor 772-595-3773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 101YM0800X) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2011-01-26 |