| NPI | 1770272668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA DODSON Credentialing Manager 443-398-0189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2024-08-06 |