| NPI | 1508526724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARANDA KEITH Owner 678-675-2272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2023-10-25 |