| NPI | 1174079107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA M GALLAGHER Credentialing Coordinator 410-893-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |