| NPI | 1851712640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L STUCKERT Manager 678-534-3824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 305S00000X Point of Service (Licence: GA LPC 004704) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2024-04-24 |