| NPI | 1780495002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE JANESTA KELLEY Program Director 410-215-2619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |