| NPI | 1134587678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY JONES Clinical Supervisor 443-438-4546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MD AC1690) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |