| NPI | 1669738621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE BLACKWOOD Clinical Director 770-365-3140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC00495) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-04 |