| NPI | 1174139133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELTON DE VOSE Executive Clinical Director 706-364-6576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-09-16 |