| NPI | 1477351906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA DAVENPORT Manager/Co Owner 386-453-8157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2025-03-03 |