| NPI | 1851354732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY FRANCIS BURNHAM Owner 321-639-4483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL MH 5004) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH 6888) |
| 103TC0700X Psychologist Clinical (Licence: FL PY0004573) | |
| 1041C0700X Social Worker Clinical (Licence: FL SW 615) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2020-08-22 |