| NPI | 1982151627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE J FULLER Owner/Director/Provider/CEO 850-584-2772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2016-09-09 |