| NPI | 1528391463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRENE JACKSON Operations Manager 443-444-4803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD D0038957) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2009-09-10 |