| NPI | 1871808550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES E. TIFT Member Manager 912-977-4663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA MSW002656) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 012789) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2010-08-18 |