| NPI | 1649776592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE BOLTWOOD Billing Manager 770-530-9051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1052189) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2019-06-30 |