| NPI | 1396292959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON JACKSON Counselor 470-238-8587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC009117) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-11-22 |