| NPI | 1679940209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLONDA H SHEPARD Owner 803-466-9061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC 008261) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2015-08-31 |