| NPI | 1275308850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONTAE D JACKSON CEO 904-474-2298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2023-11-24 |
| Last Update Date | 2023-11-24 |