| NPI | 1972650356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER J ILLUM Counselor 678-425-0975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC004396) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-08-22 |