| NPI | 1114340403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL G SLAGLE Practice Manager 410-576-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-30 |