| NPI | 1609547009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM SHAFFER Director 443-220-6122 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2024-12-30 |