| NPI | 1437548237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLYSON K WAGNAER Co Owner 410-684-3806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 04890) |
| 103T00000X Psychologist (Licence: MD 04712) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2023-05-05 |