| NPI | 1225787153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMIRAH NATARSHA JACKSON Program Administrator 240-600-0942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2022-03-19 |