| NPI | 1851567127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTA LYNNE WAGELEY Licensed Clinical Prof. Counselor 301-790-1560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MD LC1745) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |