| NPI | 1326585076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLIS MCCULLOUGH Office Manager 410-286-0664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC0630) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC1239) |
| 101YP2500X Counselor, Professional (Licence: MD LC6770) | |
| 1041C0700X Social Worker, Clinical (Licence: MD 09927) | |
| 1041C0700X Social Worker, Clinical (Licence: MD 03914) | |
| 1041C0700X Social Worker, Clinical (Licence: MD 12303) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D43972) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2017-01-19 |