Healthcare Provider Details

I. General information

NPI: 1952746588
Provider Name (Legal Business Name): CHANGING TURN COMMUNITY THERAPUETIC GROUP PRATICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 YORK RD SUITE 103
BALTIMORE MD
21212-3842
US

IV. Provider business mailing address

5438 YORK RD SUITE 103
BALTIMORE MD
21212-3842
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-1461
  • Fax:
Mailing address:
  • Phone: 443-708-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4839
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. EMMANUELLA OWOBU
Title or Position: LICENSED CLINICAL COUNSLEOR
Credential: LCPC
Phone: 443-708-1461