| NPI | 1336845304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIERRA BURLEY Credentialing Specialist 410-314-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center Rehabilitation |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2025-04-16 |