| NPI | 1720101736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA M BALLONE Clincal Director 850-837-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL 90051001284) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |