| NPI | 1477894202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSIAH MALIK JACKSON Vice President 443-473-8876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2019-03-08 |