| NPI | 1629641030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN TRETTIEN Executive Director 912-532-9308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2021-07-22 |