| NPI | 1023533106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE M FUENTES Owner 678-802-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC004808) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH7359) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2019-06-18 |