| NPI | 1962543579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MARIE CAUDILL Psychologist 678-232-9078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA 002899) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-04-24 |