| NPI | 1679512073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMSON OMOTOSHO Program Director 443-858-3189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MD 404169100) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MD 402529600) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MD 241N) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-07-19 |