| NPI | 1811519804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL LAVON JOHNSON Credentialing Specialist 561-356-6313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-05-12 |