| NPI | 1841934510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YERESA GASKINS Administrative Asst./ Credentialing 904-291-5561 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2025-03-20 |