| NPI | 1093336422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VENNIETH L. MCCORMICK Director 410-908-3106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2020-04-27 |