Healthcare Provider Details

I. General information

NPI: 1750870804
Provider Name (Legal Business Name): EMBRACING CHANGEZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GARRISON BLVD STE 210
BALTIMORE MD
21216-2309
US

IV. Provider business mailing address

2300 GARRISON BLVD STE 210
BALTIMORE MD
21216-2309
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-6086
  • Fax: 443-687-8742
Mailing address:
  • Phone: 443-869-6086
  • Fax: 443-687-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATISHA S CHRISTENSEN
Title or Position: CLINICAL DIRECTOR/CO-OWNER
Credential: LCSW-C
Phone: 443-869-6086