| NPI | 1922866011 |
|---|---|
| Doing Business As | GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC |
| Entity Type | Organization |
| Authorized Contact | BASIL E. FOMANKA CEO/Owner 443-520-8138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2024-09-04 |