| NPI | 1629210430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | G. WELLS PETRAS Owner 706-424-6674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC004835) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003613) |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2009-03-26 |