| NPI | 1023179579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA LYNN CLENDANIEL Billing Manager 410-810-2465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 231369010) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2016-10-18 |