| NPI | 1033250873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA A BALOG President 678-583-4975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: GA PSY2369) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |