| NPI | 1053664110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEONNA L WALLOP Therapist 301-850-1121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MD LC4121) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: DC PRC14226) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2012-10-25 |