| NPI | 1780821611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN KOTLER Clinical Social Worker 386-334-8430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL SW7398) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2009-01-14 |