| NPI | 1649341488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA LYNN CLENDANIEL Billing Manager 410-810-2465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 231369010) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2022-07-21 |