| NPI | 1568838316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE DERISO Counselor 410-296-2004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC3622) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |