| NPI | 1649784133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERLAND BAKER Director 904-566-1955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2022-07-21 |