| NPI | 1306192513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH F. JOHNSON Administrator Of Business 386-235-3831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL 5460) |
| Additional Taxonomies | 251S00000X (Licence: FL mh5548) |
| 101YM0800X Counselor, Mental Health (Licence: FL 5548) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5460) | |
| 103T00000X Psychologist (Licence: FL 5548) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: FL 5548) | |
| 101YP1600X Counselor, Pastoral (Licence: FL 5460) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2015-01-21 |