| NPI | 1053020412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY RENNA THOMAS Credentialing Specialist 410-661-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2025-05-06 |