| NPI | 1679155337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Licensing And Credentialing Special 410-807-8471 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2021-04-22 |