| NPI | 1184445660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIVON MASSENBURG President 443-351-8033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2024-10-18 |
| Last Update Date | 2024-10-18 |