| NPI | 1780980912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAND ROYCE BAGOON Licensed Psychologist 410-781-7263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 02686) |
| Enumeration Date | 2011-02-05 |
| Last Update Date | 2011-02-05 |