| NPI | 1558816942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA P. JACK Mental Health Counselor 407-325-0729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH8933) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2016-08-16 |