| NPI | 1801124805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAREL ROGERS Manager 850-522-1516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 1403AD1631-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW6575) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2012-06-04 |