| NPI | 1396354858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANYALIESE DOMINIQUE HANCOCK-SMITH Owner & Licensed Psychologist 386-518-6006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2021-08-02 |