| NPI | 1386370757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYL MOODY Owner 443-310-2572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2023-08-18 |