| NPI | 1588273528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE BOULAI Owner/CEO 770-683-6946 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2024-02-12 |