| NPI | 1710870423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN CONRAD Owner 904-201-9775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-06-03 |