| NPI | 1568914760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY KENNELL Billing Manager 301-722-0616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 906350) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2016-11-04 |