Healthcare Provider Details

I. General information

NPI: 1497365654
Provider Name (Legal Business Name): INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4654 YORK RD STE 1A
BALTIMORE MD
21212-4726
US

IV. Provider business mailing address

4654 YORK RD STE 1A
BALTIMORE MD
21212-4726
US

V. Phone/Fax

Practice location:
  • Phone: 410-258-6714
  • Fax:
Mailing address:
  • Phone: 410-258-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS SHAQUANNA FOSTER-DOTSON
Title or Position: PRESIDENT/ FOUNDER
Credential: LCSW-C
Phone: 410-258-6714