| NPI | 1356926695 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | MICHELE RONSISVALLE Chief Operations Officer 321-259-1662 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 103T00000X Psychologist | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| Enumeration Date | 2021-03-17 | 
| Last Update Date | 2025-07-09 |