| NPI | 1942056007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLA JACKSON CEO 443-388-0211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 1041C0700X Social Worker, Clinical | |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-04-29 |