| NPI | 1053045054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG HOWARD LIPPENS Program Administrator 410-382-0528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-09-01 |