| NPI | 1881969459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA LORRAINE JACKSON Clinical Director/Therapist 443-333-9340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC4153) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2012-03-28 |