| NPI | 1083953178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYWANDA ELLISON LIGHTFOOT Owner 770-634-2349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003343) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2013-02-08 |