| NPI | 1801495213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE MADLOCK Provider 678-360-2368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2025-10-13 |