| NPI | 1649879362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA TALBOTT Practice Director 410-952-8421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |