| NPI | 1003479668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIERRA BURLEY Credentialing Specialist 410-314-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| 251B00000X Case Management | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-04-16 |