| NPI | 1861403974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE R ODOM Office Manager 904-824-7597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY7098) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW5151) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-08-22 |