| NPI | 1679885941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BUCOVETSKY Psychologist 770-457-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003351) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2010-07-02 |