| NPI | 1487280152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI POWELL Billing Manager 301-703-8767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |