| NPI | 1801261631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYLOUSE MILLIE SAGESSE Director 904-562-1391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH10807) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2022-01-13 |