| NPI | 1588259956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE AYESHA MACON Owner 410-615-8566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-03-07 |
| Last Update Date | 2021-03-07 |