| NPI | 1114691672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NGUFOR FUBE DIVINE President 410-870-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2024-11-26 |