| NPI | 1295272482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Credentialing Specialist 443-839-6928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MD d0046457) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2021-04-07 |