| NPI | 1417523580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TUKRIA D WATLEY CEO 904-613-7836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| 251S00000X | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2021-05-31 |