| NPI | 1720526387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI ANN WILSON Owner 239-260-4387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW9293) |
| Additional Taxonomies | 251S00000X (Licence: FL SW9293) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2018-01-04 |