| NPI | 1538862370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN ANN JESSOP WAGNER Clinical Psychologist 478-929-0294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-03-22 |