| NPI | 1649169053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON PENA Licensed Clinical Social Worker 321-345-8061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-07-01 |