| NPI | 1629359807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADINAH I RALSTON Owner 770-759-3444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003079) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2011-09-01 |