| NPI | 1932415155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY WILCOX Owner 941-467-6347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL 4729CAP) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2011-01-24 |