NPI | 1518406107 |
---|---|
Entity Type | Organization |
Authorized Contact | CONNIE ELLETTA CLARK Therapist 904-743-2327 |
Organization Subpart ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH14118) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH14118) |
Enumeration Date | 2017-02-16 |
Last Update Date | 2017-02-16 |