| NPI | 1710325766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHATISHA MATRICE WILSON Executive Director 762-233-4642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006436) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LAPC002949) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2013-06-12 |