| NPI | 1689430498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Director Of Provider Enrollment 443-839-6928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-02-28 |