| NPI | 1487172078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ERVIN Social Worker 407-631-4573 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW13482) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2022-07-21 |