| NPI | 1649004680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DETRECE LAVENDER Owner 240-565-0569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2024-08-30 |
| Last Update Date | 2024-08-30 |