| NPI | 1134367378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LESLIE MAYO President 770-956-9212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 1582) |
| Additional Taxonomies | 251S00000X (Licence: GA 1582) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2013-05-28 |