| NPI | 1205695194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSHAWN KINGSBERRY CEO 706-240-0371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-05-21 |