Healthcare Provider Details

I. General information

NPI: 1104745678
Provider Name (Legal Business Name): INNER CHANGE COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6008 STUART AVE
BALTIMORE MD
21209-4020
US

IV. Provider business mailing address

6008 STUART AVE
BALTIMORE MD
21209-4020
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-6792
  • Fax:
Mailing address:
  • Phone: 410-929-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAVID LEVI
Title or Position: OWNER
Credential: LCSW-C
Phone: 410-929-6792