| NPI | 1255080628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA SHANNON Owner 443-834-6960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-03-24 |