| NPI | 1780030668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN GODWIN Director Of Revenue 706-389-6789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2016-08-18 |