| NPI | 1336897107 |
|---|---|
| Former Legal Business Name | LIFESPAN BEHAVIORAL HEALTH SERVICES PC |
| Entity Type | Organization |
| Authorized Contact | JOSHUA SUSSAL CEO/Md 301-982-3437 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-03-11 |