| NPI | 1245942606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THELMA PAINE Nurse Practitioner 410-513-6501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2022-12-16 |