| NPI | 1194312454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN POLANCO Owner 443-331-5959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2020-12-29 |