| NPI | 1871990697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN KIRBY WALLACE Manager 321-795-7701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH10904) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2014-11-21 |