Organization
PANAMA YOUTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE JAMES GREEN JR. M.S. (EXECUTIVE DIRECTOR)
(904) 527-3953
Entity
Organization
Contact information
Practice address
7287 WILDER AVE, JACKSONVILLE, FL 32208
(904) 527-3953
(904) 683-0067
Mailing address
402 EAST 63RD STREET, JACKSONVILLE, FL 32208
(904) 527-3953
(904) 683-0067
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0416AD444101
FL
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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