| NPI | 1285274522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAWANYA TENE JERRY Medical Biller 443-221-7447 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult | |
| 251S00000X | |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2020-01-15 |