| NPI | 1548776412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE STORRUSTEN Owner 404-401-2587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA CSW004317) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2017-12-14 |