| NPI | 1376059329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE LORENZ Contracting Manager 386-337-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2018-03-17 |