| NPI | 1205527850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LERIN JACKSON Medical Director 443-488-3645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |