| NPI | 1659617215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE DESHON MASON Director 813-223-4260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL sw-9357) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL sw-8894) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2012-12-28 |