| NPI | 1457739609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN PATRICIA CAPITANO Owner 904-610-6276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH5716) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2022-09-23 |