| NPI | 1568174126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LIVELY COO 443-631-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2023-02-10 |