| NPI | 1730661752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISABETH PESCE Secretary 904-605-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC0700X Psychologist Clinical | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2023-03-30 |