| NPI | 1720232804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXINE M. RUSSELL Mental Health Counselor 239-591-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH4166) |
| Enumeration Date | 2008-11-16 |
| Last Update Date | 2008-11-16 |