| NPI | 1982079091 | 
|---|---|
| Doing Business As | IEISHA FARRELL | 
| Entity Type | Organization | 
| Authorized Contact | IEISHA T FARRELL Solo Provider 850-445-8821 | 
| Organization Subpart ? | Yes | 
| Primary Taxonomy | 251S00000X Community/Behavioral Health | 
| Enumeration Date | 2015-12-01 | 
| Last Update Date | 2015-12-01 |