| NPI | 1720507106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARMAINE FORTS Manager 404-453-6356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2017-09-16 |
| Last Update Date | 2020-12-10 |