| NPI | 1154658656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE D DAVIS Program Director 678-778-4342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 09076069) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2009-11-04 |