| NPI | 1730911850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LEWIS Owner 863-288-1772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-08-16 |