Healthcare Provider Details

I. General information

NPI: 1174433445
Provider Name (Legal Business Name): CHANCE TO CHANGE SUPPORTIVE SERVICES OF MARYLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST FL 8
BALTIMORE MD
21202-3180
US

IV. Provider business mailing address

18980 HARBOR SIDE BLVD
MONTGOMERY TX
77356-3224
US

V. Phone/Fax

Practice location:
  • Phone: 229-809-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHESTINE WASHINGTON
Title or Position: OWNER
Credential:
Phone: 229-809-0300