| NPI | 1548936438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FALLON JACKSON CEO 305-504-4259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-01-19 |