| NPI | 1790854222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELANA TERRY Program Director 770-451-6838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA LPC003650) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |