| NPI | 1952179384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEISHA WILSON Director 678-330-7298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2023-12-14 |