| NPI | 1639477631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE TUCKER Billing 410-268-8191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0060343) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD D0060343) |
| 101YP2500X Counselor, Professional (Licence: MD D0060343) | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2023-02-20 |