| NPI | 1568214534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY MARVIN Owner 443-431-9695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-04-06 |