| NPI | 1417217050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMELIA BEVERLY BALLAH Director 770-882-4031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW003836) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2012-05-16 |