| NPI | 1609529767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIEL CHICHEPORTICHE Program Sponsor 410-484-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-01-29 |
| Last Update Date | 2022-01-29 |