| NPI | 1952757395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON M ELLER Clinical Director 678-408-4588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA MFT0001231) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA PC005894) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |