| NPI | 1710742036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIP VAN THOMPSON Practicing Owner 770-856-6359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2024-02-15 |