| NPI | 1508393828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKIE COLE Owner 706-224-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA CSW005839) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2023-01-24 |