| NPI | 1649065574 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | HENRY TAMA Lpn 301-323-8520 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent | 
| Enumeration Date | 2025-04-11 | 
| Last Update Date | 2025-04-11 |