| NPI | 1578855276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHA BROUSSARD Program Director 678-449-8040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1595-03-001) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |