| NPI | 1609428689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLEEN CLAIRE WODZENSKI Director Of Program Development 770-686-0894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2019-07-10 |