| NPI | 1457755530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE VAVILALA Owner 904-318-6109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6901) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |