| NPI | 1497407506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WIDENER Owner 678-577-8795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-01-25 |