| NPI | 1508599143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KNITIKIA GROSS Owner 678-458-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2022-07-01 |