| NPI | 1417481235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA LYNN HENDERSON Mental Health Counselor 321-710-5649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: FL mh12311) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-27 |