| NPI | 1922677145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY RENNA THOMAS Credentialing/Provider 410-663-4036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2022-07-28 |