| NPI | 1356003081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRIS WEAVER President 813-252-6114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-20 |