| NPI | 1730622564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | URSULA MICHELLE DAVIS Owner 678-862-3383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: GA LPC006950) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2016-11-28 |