| NPI | 1487167227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZA CRISTIN PROVENZANO Owner/Counselor 904-568-5826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH9038) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2017-11-15 |