Healthcare Provider Details

I. General information

NPI: 1861031155
Provider Name (Legal Business Name): AMINA T CHANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15911 POINTER RIDGE DR
BOWIE MD
20716-1742
US

IV. Provider business mailing address

6200 WESTCHESTER PARK DR APT 810
COLLEGE PARK MD
20740-2838
US

V. Phone/Fax

Practice location:
  • Phone: 240-899-3919
  • Fax:
Mailing address:
  • Phone: 240-725-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200007913
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: