| NPI | 1619481793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JHOANE LALEAU Owner 321-266-5166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2018-06-20 |