| NPI | 1629471958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI N SCOGGIN Credentialing Coordinator 410-893-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2017-03-08 |