| NPI | 1073137972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA WILSON Owner 443-779-9901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |