| NPI | 1679313761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA BOURSIQUOT Owner 240-413-1255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2025-07-17 |