| NPI | 1003562299 |
|---|---|
| Former Legal Business Name | LIFESPAN BEHAVIORAL HEALTH SERVICES PC |
| Entity Type | Organization |
| Authorized Contact | JOSHUA SUSSAL Md/CEO 301-982-3437 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-02-25 |