| NPI | 1649718974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA NIXON Owner 386-255-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH6317) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2020-04-29 |