| NPI | 1861895450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYEAST REYNOLDS Director Rcm 678-813-0428 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2019-04-11 |