| NPI | 1790453900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LATASHA SHELL Provider 410-800-6186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2026-07-07 |