| NPI | 1073906707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN MOORE President 678-644-0039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003755) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY003755) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY003755) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY003755) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA PSY003755) | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2015-03-04 |