| NPI | 1427890243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBRIA JACQUELYN PAGE Provider/Owner/Authorized Person 904-315-9248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2024-06-11 |