| NPI | 1043906662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLASS HART PAUL Owner/Operator 678-477-8747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-04-17 |