| NPI | 1295065530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISABETH PESCE Secretary 904-605-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OR 539991) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OR C2145) |
| 106H00000X Marriage & Family Therapist (Licence: OR T0624) | |
| Enumeration Date | 2010-01-09 |
| Last Update Date | 2023-02-07 |