| NPI | 1992588123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK OWENS Owner 443-517-6237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-08-14 |