| 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 | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2012-05-16 |