Healthcare Provider Details

I. General information

NPI: 1679480347
Provider Name (Legal Business Name): MAKING DIFFERENT CHOICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 ARUNAH AVE
BALTIMORE MD
21216-4822
US

IV. Provider business mailing address

9305 GROFFS MILL DR # 9305
OWINGS MILLS MD
21117-6139
US

V. Phone/Fax

Practice location:
  • Phone: 443-895-8207
  • Fax:
Mailing address:
  • Phone: 443-985-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TYRELL NMN LASTER
Title or Position: CEO
Credential: ADT
Phone: 443-985-6565