| NPI | 1699319491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELEECIA TUCKER Clinical Director 904-536-4415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2023-12-04 |