| NPI | 1790222024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONDRA WILBANKS Member 770-851-4641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC007627) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |