| NPI | 1003263914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RIKKI CLARK MCCOY Owner 678-322-7935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA CSW005758) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-09-19 |