| NPI | 1629461405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN BUSH Practice Manager 678-974-2162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 103T00000X Psychologist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2024-10-31 |