| NPI | 1942377593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LANE Controller 410-358-5252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |