| NPI | 1285267815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE PEGRAM Psychotherapist 912-660-1312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |