| NPI | 1245036805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE GILLIAM Owner 410-801-8828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-06-05 |