| NPI | 1215744610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DAVID DONOVAN Lcadc 410-740-8066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2024-12-18 |