| NPI | 1902239270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY M RILEY Owner 904-704-2527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW9355) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 5716) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME0045122) | |
| 251S00000X | |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2018-08-10 |