| NPI | 1922852862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEKESHA M TYSON CEO Of Formations Health 443-846-9239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-04-16 |