| NPI | 1225570625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRA SHANICE ROBERTS Program Director 410-517-4279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD MH-2173) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2016-11-16 |