| NPI | 1710378419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON ALISHA WOMACK Program Director 410-878-6404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MD 1493) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-02-17 |