| NPI | 1780327635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA SYKES Program Director 904-576-7491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-07-06 |