| NPI | 1508409319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARISSE DIAZ CEO 813-601-0595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2023-08-22 |