| NPI | 1922673227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOJAUNA JACKSON-FORBES Owner 321-263-6994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-05-20 |