| NPI | 1326827494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA MIRIAM AGATINA WYKE Owner 904-333-0881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2023-09-27 |