| NPI | 1467152645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN G WOLSTEIN Owner 727-906-7221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-03-07 |