| NPI | 1609172337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LEWIS Office Manager 904-619-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH5542) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW1539) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2011-01-27 |