| NPI | 1295332351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYONA DAVIS CEO/President 443-961-7523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |