| NPI | 1760932529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA G. STANFORD Chief Executive 904-396-9144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 1539) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |