| NPI | 1972956464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY BEARD ELIAS Owner 678-520-7260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9658) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |