| NPI | 1336930841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY L LAROCHE Psychiatric Nurse Practitioner 386-222-3978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-07-30 |