NPI age
17 years
Enumerated 2008-10-21
Across 7547 active counselor providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 170428375B | |
| 01 | 11878515 | CAQH PROVIDER ID |
| 01 | 424748 | MHN PROVIDER ID |
Part of a multi-provider practice. 8 other active providers share this practice address in NPPES.
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