| NPI | 1871041848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM DAVIS Executive Director 7062-929-9024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: GA APC005441) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-09-19 |