| NPI | 1881286425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYWANNA HAMILTON Medical Director 443-550-4448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2021-02-05 |