| NPI | 1639567712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA JOHNSON Therapist 229-224-2407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: GA LPC007623) |
| Additional Taxonomies | 251B00000X Case Management (Licence: GA LPC007623) |
| Enumeration Date | 2014-12-25 |
| Last Update Date | 2014-12-25 |