| NPI | 1740301373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATJANA ESTEP RAYCROFT Clinical Social Worker 706-833-7601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 3760) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: GA APC001457) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |