| NPI | 1679106538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN WEHBERG Owner 410-912-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2024-05-31 |