| NPI | 1194013912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RACKLEY LUCY Owner 404-513-6077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY001911) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2021-05-26 |