| NPI | 1801219365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM HONECKER Manager 410-707-3931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 149016089) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2014-02-03 |