| NPI | 1275203275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Credentialing Specialist 443-839-6928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2025-02-28 |