| NPI | 1174094726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIELLE ANGELA STAIR Owner/Operator 706-514-1213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2019-12-31 |