| NPI | 1518625029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LAKE Owner 410-901-7243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2021-12-01 |