| NPI | 1477315489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA N PORTER Credentialing Consultant 443-255-3135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-02-13 |