| NPI | 1336701457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN GOLLOPP Manager 786-560-7496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 104100000X Social Worker | |
| Enumeration Date | 2019-06-29 |
| Last Update Date | 2019-06-29 |