| NPI | 1730155185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA LEE BOUCHARD TEUBER Licensed Clinical Social Worker 321-637-3788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 7842) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP 2661) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2008-06-17 |