| NPI | 1700134277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD R HART Owner 904-280-4491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY001838) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY001838) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: GA PSY001838) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY001838) | |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY001838) | |
| 103TC1900X Psychologist, Counseling (Licence: GA PSY001838) | |
| 103TH0004X Psychologist, Health (Licence: GA PSY001838) | |
| 103TH0100X Psychologist, Health Service (Licence: GA PSY001838) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA PSY001838) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: GA PSY001838) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |