| NPI | 1437375615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD GRAY MEDLIN Owner,Program Director 301-627-3007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MD LCA352) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA352) |
| 101YM0800X Counselor, Mental Health (Licence: MD LCA352) | |
| 103T00000X Psychologist (Licence: MD LCA352) | |
| 103TF0000X Psychologist, Family (Licence: MD LCA352) | |
| 103TH0100X Psychologist, Health Service (Licence: MD LCA352) | |
| 106H00000X Marriage & Family Therapist (Licence: MD LCA352) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD LCA352) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2013-03-19 |