| NPI | 1851354732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY FRANCIS BURNHAM Owner 321-639-4483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL sw 615) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL py0004573) |
| 101YM0800X Counselor, Mental Health (Licence: FL mh 6888) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL mh 5004) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2020-08-22 |