| NPI | 1104300250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISOM E WHITE Therapist 678-392-8173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2019-07-15 |