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Behavioral Health & Social Service Providers Counselor Professional

Provider NPI: 1356339097

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 404-509-5883  Fax: --

Business Mailing Address:
Tel: 404-509-5883  Fax: --

NPI Information:
NPI: 1356339097
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YP2500XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 101YP2500X





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