| NPI | 1700179868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A. DAVIS Program Manager 904-353-2949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL MH1184) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2011-05-24 |