| NPI | 1770762593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE RICHARD DEROCHE Owner Private Practice 386-439-1403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH0000050) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2007-11-27 |