| NPI | 1124913728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIERRA BURLEY Credentialing Specialist 410-314-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |