| NPI | 1821541137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOTT RICHELSON Authorized Official 904-514-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 101YP2500X Counselor, Professional | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2023-06-29 |