| NPI | 1669605127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HALISI EDWARDS STATEN Licensed Psychologist 678-768-1214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002858) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA C0067) |
| 103TF0000X Psychologist, Family (Licence: GA PSY002858) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA PSY002858) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |