| NPI | 1265941066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKAELA N HEARD Owner 678-748-0128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: GA LPC007304) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2017-10-03 |