| NPI | 1689274698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAVIS Credentialing Specialists 912-373-4385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2025-07-30 |