| NPI | 1003261637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNZE VICKERS Owner 334-401-0595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT001430) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-05-02 |