| NPI | 1720454572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERMAINE ANTONIO WALL Licensed Clinical Social Worker 407-694-8704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005532) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-20 |