| NPI | 1396169819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD VILMENAY Lcsw 813-892-6203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW8425) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH9398) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-03-10 |