| NPI | 1295164549 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | TIFFANY LYNN SULLIVAN Owner 678-814-4375 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007416) | 
| Enumeration Date | 2013-11-07 | 
| Last Update Date | 2023-11-04 |