| NPI | 1871007161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONI R. HENRY Provider/Therapist 770-609-1973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 006759) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2017-11-25 |