| NPI | 1972927861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE D. LANE President/CEO 678-677-4041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 251S00000X | |
| 251V00000X Voluntary or Charitable | |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-02-12 |