| NPI | 1700619160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA DUBALL Licensed Professional Counselor 941-702-4752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2026-02-05 |