| NPI | 1780146100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERONICA PETKUS Licensed Mental Health Counselor 386-212-3643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2019-06-11 |