| NPI | 1760834071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE CLARK Office Manager 770-339-7667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA lpc008814) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2022-10-24 |