| NPI | 1639435829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUBRINA L RUSH Owner 678-622-7973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC004530) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2012-04-02 |