| NPI | 1467003079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MARIE FUSCO Manager 904-347-0843 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2021-06-02 |