| NPI | 1063730349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE C FONROSE Therapist/Counselor 240-533-5784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MD LC3487) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: MD LC3487) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2014-03-05 |