| 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 |