| NPI | 1952352189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA HERNANDEZ Administrator 904-824-7597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: FL HCC7024) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2008-01-30 |