| NPI | 1679425144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARIDJA STEPHANIE GOHOURE Owner 240-701-2670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-03-16 |