| NPI | 1023568755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA DELAINA BALL Owner 607-795-1235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003839) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2021-09-27 |