| NPI | 1750863130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA DENITA SHEALEY CEO 904-404-8113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| 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 | 2018-09-03 |
| Last Update Date | 2022-10-04 |