| NPI | 1306618897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNISHA LUCAS Director 443-605-5086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2023-10-27 |