| NPI | 1235406265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADELINE MCTAVOUS Owner 443-895-4183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD LC3272) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |