| NPI | 1417625419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATREVA DUPONT Director 904-718-9672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2021-09-08 |