| NPI | 1699544650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WILSON Nurse Practitioner 410-961-0897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-01-01 |
| Last Update Date | 2024-11-04 |