NPI age
17 years
Enumerated 2009-04-02
Across 5527 active counselor providers in Georgia.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (NH) | 12119524 | CAQH APPLICATION # |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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