| NPI | 1154744571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIARI MARCUS BANIGO Director 410-900-3147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MD 15059) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |