| NPI | 1366632812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C VINCENT DIX Provider 850-878-1142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY002151) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-11-14 |