NPI | 1710589205 |
---|---|
Entity Type | Organization |
Authorized Contact | MIA R WILSON Lmhc 904-891-6614 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
Enumeration Date | 2020-11-10 |
Last Update Date | 2020-11-10 |