| NPI | 1154971240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY EKMARK Owner 770-375-2143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |