| NPI | 1508353210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIUS JESSUP PETERSON Owner 404-698-5553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005018) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2018-04-18 |