| NPI | 1376908525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES STEVENS Owner 321-777-9961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY4176) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2015-12-15 |