| NPI | 1033663034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY GOODRICH Director 678-782-7180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 16002584) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |