| NPI | 1598216061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE M TIDWELL Therapist 678-677-7484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: GA Not Issued Yet) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |