| NPI | 1356502728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY S. MIRABILE Owner/Medical Direcctor 904-733-7383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 0416AD268700) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2019-10-24 |