| NPI | 1497216451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI TALLEY Clinician 706-755-5324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2019-12-26 |