| NPI | 1700445350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA LEE Manager 706-587-0934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2019-06-11 |