| NPI | 1871033654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA RICKARD Organizer 912-421-9050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003907) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2020-05-11 |