Healthcare Provider Details

I. General information

NPI: 1649971847
Provider Name (Legal Business Name): CHANGINGPERSPECTIVES22 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 VINE ST
CAPITOL HEIGHTS MD
20743-5621
US

IV. Provider business mailing address

4219 VINE ST
CAPITOL HEIGHTS MD
20743-5621
US

V. Phone/Fax

Practice location:
  • Phone: 443-310-2569
  • Fax:
Mailing address:
  • Phone: 443-310-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KWAME H CARTER
Title or Position: OWNER
Credential: LPC
Phone: 443-310-2569