| NPI | 1992230338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ANNETTE POWELL Therapist 410-645-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MD 15042) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2020-07-15 |