| NPI | 1275382871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LORRAINE TICKNOR Owner/Physician 410-205-9205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-05-15 |