| NPI | 1588204374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TISA STANLEY Enrollment Specialist 770-284-1787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-01-09 |