| NPI | 1326875238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Credentialing Specialist 443-839-6928 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2024-09-16 |