| NPI | 1336347533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVETTE LOPEZ BLEDSOE Therapist/Owner 706-395-3091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA CSW005801) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CO 627) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2018-10-11 |