| NPI | 1982112231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANA JO VIVIAN Therapist 678-836-9263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: GA LPC009559) |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2018-01-19 |