| NPI | 1710854054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REAGAN L WADE Office Manager 443-528-4014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-10-21 |
| Last Update Date | 2025-10-21 |