| NPI | 1407357437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA D HAIRSTON Owner/Administrator 386-451-0684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH12217) |
| Enumeration Date | 2018-02-25 |
| Last Update Date | 2020-06-15 |