| NPI | 1174175632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN RECK Manager 410-220-0780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2022-05-11 |