| NPI | 1992584155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE ANN CARTER Licensed Mental Health Counselor 321-591-6286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2023-09-27 |