| NPI | 1639324817 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | ELISABETH PESCE Secretary 904-605-4986  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005107A)  | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001690A)  | 
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2008-12-01 | 
| Last Update Date | 2025-03-24 |