| NPI | 1184070575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLA L BOSTON Licensed Psychologist 770-953-4744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003953) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |