| NPI | 1790340065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMONIQUE JACKSON Owner 904-637-5297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2020-06-25 |