| NPI | 1669843108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANNA ALIS Clinical Therapist 239-258-5520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9268) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |