| NPI | 1689198731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUANDA JEFFERSON Psychotherapist 678-468-0442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251B00000X Case Management |
| 252Y00000X Early Intervention Provider Agency | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2021-01-21 |