| NPI | 1235546375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA TROLL S. THOMAS CEO 678-982-4046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC0003912) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |