| NPI | 1437884376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA'SHAWN C PETERSON Sole Mbr 850-290-2147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 251K00000X Public Health or Welfare | |
| 251S00000X Community/Behavioral Health | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2022-07-22 |