| NPI | 1326404542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE MCCULLOUGH Counselor 813-253-6250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH7180) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |