| NPI | 1780019323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN ELENA LANGE Member 301-437-1381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT Lic201303289) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2013-09-13 |