| NPI | 1013423672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVON BLACKWOOD Owner 443-570-5402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD LCADC) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2017-12-19 |