| NPI | 1326559097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA PAYNE Owner 904-629-1565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH13243) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2019-03-12 |