| NPI | 1669286688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE NICOLETTE Licensed Mental Health Counselor 772-202-5661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2025-08-29 |