| NPI | 1104369537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GIBBS Owner 443-559-0450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD 100757) |
| Enumeration Date | 2016-12-03 |
| Last Update Date | 2016-12-03 |