| NPI | 1184756090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHEAL DAVID BANOV Owner 770-422-2009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2019-08-01 |