| NPI | 1144374604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE CAVASIN Manager Provider Enrollment 404-785-0195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-03-13 |