| NPI | 1104188341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA MARIE DAVIS Pychotherapist 478-662-2710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: GA CSW003584) |
| Additional Taxonomies | 251S00000X (Licence: FL SW7900) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2019-01-22 |