| NPI | 1376178756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DILLON GARRETT WELLIVER Owner/Private Practice 850-320-2071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-06 |