| NPI | 1245956994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY COLEY Owner 443-621-1580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2022-10-14 |