| NPI | 1780143842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD BRUCE EDMONSTONE Owner 404-973-7611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2022-12-06 |