| NPI | 1700460250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARISSA L DORE CEO 904-339-5937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2022-03-29 |