| NPI | 1083352843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISHA M GINGLES Owner 443-304-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-05-23 |