Healthcare Provider Details

I. General information

NPI: 1104213032
Provider Name (Legal Business Name): CHANGING DIRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E NORTHERN PKWY SUITE 310
BALTIMORE MD
21239-2113
US

IV. Provider business mailing address

1900 E NORTHERN PKWY SUITE 310
BALTIMORE MD
21239-2113
US

V. Phone/Fax

Practice location:
  • Phone: 443-333-4777
  • Fax: 443-333-4778
Mailing address:
  • Phone: 443-333-4777
  • Fax: 443-333-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: TASHA SAUNDERS
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 443-333-4777