| NPI | 1063144624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA'DEA MIRANDA WRIGHT CEO/Director 678-993-5881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 310500000X Intermediate Care Facility, Mental Illness | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2022-06-30 |