| NPI | 1902212111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE VAUGHN Owner/Operator 706-618-6578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 2843) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TN 2955) |
| 101YP2500X Counselor Professional (Licence: TN 2955) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TN 2843) | |
| 103TC0700X Psychologist Clinical | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN 2843) | |
| 103TF0000X Psychologist Family (Licence: TN 2843) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TN 2843) | |
| 251B00000X Case Management | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-02-20 |