| NPI | 1538608112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALENA SMITH-FULWILEY Owner 904-476-9064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12125) |
| Additional Taxonomies | 251S00000X (Licence: FL MH12125) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2017-02-16 |