| NPI | 1275689812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILDA G BROADWELL Psychologist 772-692-8585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 1943AD620400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5591) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2012-10-23 |