| NPI | 1629402094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN A WAGNER Owner 678-871-5927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC006769) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |