| NPI | 1003056698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TODD WILSON President 770-623-3331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: GA LPC004107) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2009-02-23 |