| NPI | 1659229565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALILA FORDHAM Psychologist 678-664-7336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0200X Psychologist, Forensic | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2026-03-17 |
| Last Update Date | 2026-03-17 |