| NPI | 1346586567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY MIMS Clinical Director 410-905-5678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC5081) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC5081) |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC5081) | |
| Enumeration Date | 2012-12-15 |
| Last Update Date | 2012-12-15 |