| NPI | 1063292092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKIEDRA D WHITE Lpc 404-692-6913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YS0200X Counselor School | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-06 |