| NPI | 1760828677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY GANTLIN-MONROY Therapist/CEO 678-508-3552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251S00000X (Licence: GA APC003620) |
| 251S00000X (Licence: GA LPC008821) | |
| Enumeration Date | 2013-05-18 |
| Last Update Date | 2019-01-11 |