| NPI | 1528325610 |
|---|---|
| Other Name | LICENSED CLINICAL SOCIAL WORKER |
| Entity Type | Organization |
| Authorized Contact | RUTH LYNNE GRACE President 321-759-4325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 6089) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2014-06-03 |