| NPI | 1093048324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA SROKA Office Administrator 770-997-1738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY0001477) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA LPC003891) |
| 101YP2500X Counselor Professional (Licence: GA LPC0006197) | |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2012-11-27 |