| NPI | 1053902502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNESSA MILLICENT DEVONISH Owner/ CEO 301-219-6955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2021-02-09 |