| NPI | 1952660698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH LYNN NICKENS Owner 321-506-4625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH8021) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-05-15 |