| NPI | 1245730001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM I BOLEN Director 770-658-9012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC005921) |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2018-06-16 |