| NPI | 1306698311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAJUANA DENISE RUSHIN Clinical Director 407-929-9019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 251B00000X Case Management | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-04-03 |