| NPI | 1528448404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFINIE CARROLL Executive Director 410-363-3713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD 404629300) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD ATC110) |
| 101YP2500X Counselor, Professional (Licence: MD LC3003) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2015-11-19 |