| NPI | 1750945689 |
|---|---|
| Doing Business As | SUNNYSIDE LOVE EXTRAVAGANT GROUP |
| Entity Type | Organization |
| Authorized Contact | TABITHA SHERELLE TAYLOR-BOONE Clinical Social Worker 786-575-3801 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 251S00000X | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2019-07-25 |