| NPI | 1326075300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL W HALLMON Operations Director 386-734-4233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 1264ad5284) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 1264ad5284) |
| 106H00000X Marriage & Family Therapist (Licence: FL 1264ad5284) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-08-22 |