| NPI | 1821468539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA C OLIVARES Clinical Supervisor 321-442-6665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11233) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-001479-2014) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-12-04 |