| NPI | 1386163939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN WATKINS LACY Owner 904-907-1070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME128307) |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2022-07-21 |