| NPI | 1730926916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN W AHAVA Psychologist/Sole Member 478-595-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2024-07-13 |
| Last Update Date | 2024-07-13 |