Healthcare Provider Details

I. General information

NPI: 1396688271
Provider Name (Legal Business Name): DYNAMIC CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LONG ISLAND AVE APT B
BALTIMORE MD
21229-4010
US

IV. Provider business mailing address

7651 MANDRAKE CT UNIT 305
ELKRIDGE MD
21075-7985
US

V. Phone/Fax

Practice location:
  • Phone: 443-537-5246
  • Fax:
Mailing address:
  • Phone: 443-537-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SUDIA CORBIN
Title or Position: DIRECTOR
Credential:
Phone: 443-537-5246