| NPI | 1609190750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE I JAMISON Lc Sw C 301-856-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 10425) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 04071) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-08-31 |