| NPI | 1174947071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE R ELLINGTON Owner 678-933-1883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP1600X Counselor, Pastoral | |
| 101YP2500X Counselor, Professional | |
| 102X00000X Poetry Therapist | |
| 103G00000X Clinical Neuropsychologist | |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 1041S0200X Social Worker, School | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-02-12 |