| NPI | 1619760394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHA ROSS Owner 443-813-9961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2025-05-27 |