| NPI | 1043857709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID L JAQUESS Owner 470-337-9695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |