| NPI | 1073087136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHA ROSS Owner 443-813-9961 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2021-03-16 |