| NPI | 1104418284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYWANNA HAMILTON Medical Director 410-855-4448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-02-09 |