| NPI | 1407545353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLYSON KETT WAGNER Owner 410-544-1598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2023-05-05 |