| NPI | 1568436962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE NICHOLAS 325 Mdg Commander 850-283-7515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY5848) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2008-06-13 |