| NPI | 1619363884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEREKA SHUNTA' SHAW Licensed Professional Counselor 404-234-4570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: GA LPC007419) |
| Additional Taxonomies | 251B00000X Case Management (Licence: GA LPC007419) |
| 252Y00000X Early Intervention Provider Agency (Licence: GA LPC007419) | |
| 305R00000X Preferred Provider Organization (Licence: GA LPC007419) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: GA LPC007419) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2015-04-14 |