| NPI | 1285144949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY SUZANNE GORDON Therapist 904-853-7780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 14099) |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2017-10-09 |