| NPI | 1457984643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA JOHNS Owner 863-258-6954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2020-02-18 |