| NPI | 1427650050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HETALBABU THAKORE Sole Member 706-267-7681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103G00000X Clinical Neuropsychologist | |
| 1041C0700X Social Worker Clinical | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2020-11-09 |