| NPI | 1750999066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CLOYD Secretary 904-605-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2023-10-19 |