| NPI | 1922566553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MESHA ELLIS Psychologist 678-538-6450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 174H00000X Health Educator | |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2020-05-01 |