| NPI | 1164655387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA WYNN Owner 770-689-6537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC004071) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2009-09-04 |