| NPI | 1639758113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOMO EKWENZI GRAY Co Owner 240-621-0215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2022-08-17 |