| NPI | 1629857800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY LYN SHAW Owner 240-520-8712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2023-09-26 |