| NPI | 1144599572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK MARTIN LONG Psychotherapist 410-744-5499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 03068) |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |