| NPI | 1295313963 |
|---|---|
| Former Legal Business Name | 20119 GOSS HOLLOW LANE |
| Entity Type | Organization |
| Authorized Contact | NKEM OKOLI Manager 240-351-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2021-04-01 |