| NPI | 1750453270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN SUE FULLER Director 772-220-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH3692) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL MH3692) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2010-10-06 |