| NPI | 1730817149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINAL A. WALLACE Licensed Clinician Social Worker 863-529-3725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2022-08-12 |