| NPI | 1972016210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL DENEA Owner 904-471-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2017-12-27 |