| NPI | 1619545118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAYLEY M KING Owner 678-761-6496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-06-12 |
| Last Update Date | 2021-06-12 |