| NPI | 1770011058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON MULLEN MAGBALON Owner 229-233-8009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003406) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY003712) |
| 1041C0700X Social Worker Clinical (Licence: GA LCSW004523) | |
| 106H00000X Marriage & Family Therapist (Licence: GA LMFT001440) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2017-05-31 |