| NPI | 1558685990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L STUCKERT Manager 678-534-3824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC004704) |
| Enumeration Date | 2010-03-14 |
| Last Update Date | 2010-03-14 |