| NPI | 1417443094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRA FAIRLINE RICKETTS Owner 352-587-2378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH16109) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH16109) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2023-03-17 |