| NPI | 1396494340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAVIS Credentialing Specialists 912-373-4385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2022-03-18 |