| NPI | 1619792041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENA M. ABEL Owner 321-430-5419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2024-11-21 |