| NPI | 1699124362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Administrative 410-366-1980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2020-01-16 |