| NPI | 1356978118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA VANDEVELDE MORENO Marriage And Family Therapist 229-392-5273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2021-08-13 |