| NPI | 1659978732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVA MARIE COSTLOW Clinical Supervisor 301-663-6135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |