| NPI | 1639958507 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | KOURTNEY HUNTER-SAMS Owner 410-812-0829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2023-09-28 |