| NPI | 1851177224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIE JOHNSON Clinical Director 443-858-0905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2023-09-01 |