| NPI | 1982496022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMY AMILCA Manager 772-248-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-05-22 |
| Last Update Date | 2025-08-29 |