| NPI | 1114565553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA KIMBRO Director Of Finance 706-633-3384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2019-12-17 |