| NPI | 1629364666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA ELIZABETH JACKSON Executive Director 443-910-4797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC3588) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |