| NPI | 1548411101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT MONTES Owner/Operator 678-366-8862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: GA PSY0002798) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 002798) |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY0002798) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: GA PSY0002798) | |
| 103TF0000X Psychologist, Family (Licence: GA PSY0002798) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2014-12-30 |