| NPI | 1689760837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA DEFAZZIO Director Of Clinical Services 386-523-1440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MHC6336) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |