| NPI | 1891317525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE WALLACE Owner/CEO 386-383-4562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2025-05-10 |