| NPI | 1407350630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATTAKKA S SALLEY General Partner 478-273-3086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 251B00000X Case Management | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2021-08-20 |