| NPI | 1669155800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIDRAYA BUSSIE Owner 904-728-8021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-08-14 |