| NPI | 1902490154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAFAYAT OLABISI BELLO-OGUNDIPE Program Director 571-232-9182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent | |
| 261Q00000X Clinic/Center | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-11-09 |