| NPI | 1003967563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNNY S PARK Therapist 240-472-3216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0904005471) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MD 11220) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |