| NPI | 1366141681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ELLIS VP 706-529-9692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC0700X Psychologist Clinical | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0200X Psychologist Forensic | |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-03-01 |