| NPI | 1417481235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA LYNN HENDERSON Owner 321-710-5649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: FL mh12311) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-09-06 |