| NPI | 1326762816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIAN MONET WILSON Owner 904-597-6303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |