| NPI | 1295075190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA JOHNSON Owner/Manager 904-302-5340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MT2673) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2016-11-08 |