| NPI | 1063034643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TISA STANLEY Credentialing Specialist 404-827-8038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-05-17 |
| Last Update Date | 2024-03-20 |