| NPI | 1023405271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE CERJAN Licensed Clinical Psychologist 229-255-3099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC007520) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA LPC006319) |
| 103TC0700X Psychologist Clinical (Licence: GA PSY002049) | |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2020-01-09 |