| NPI | 1376091249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE UKAEGBU Owner 443-857-4294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X (Licence: MD MH-2096) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2021-07-19 |