| NPI | 1760980502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN COUGHLIN Managing Member 386-449-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW14331) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-05-15 |