| NPI | 1932635125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE C LAKE Business Owner 786-749-2275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 10806) |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2022-03-20 |