| NPI | 1265745517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW GOTHARD Owner 770-457-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |