| NPI | 1285255307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETTY NGONA Program Director 443-465-9958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2021-11-29 |