| NPI | 1184164014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYN R WALKER CEO 301-441-1605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: DC 400312000595) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2017-03-01 |