| NPI | 1639425150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYLE COALWELL Counselor 770-298-5094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC002580) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |