| NPI | 1487320883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRA FAIRLINE RICKETTS Owner 352-587-2378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2022-11-15 |