Healthcare Provider Details

I. General information

NPI: 1780121392
Provider Name (Legal Business Name): LIFE CHANGE THERAPY NOW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2017
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BYTE CT STE G
FREDERICK MD
21702-8724
US

IV. Provider business mailing address

21 BYTE CT STE G
FREDERICK MD
21702-8724
US

V. Phone/Fax

Practice location:
  • Phone: 301-846-7872
  • Fax: 301-846-7973
Mailing address:
  • Phone: 301-846-7872
  • Fax: 301-846-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19553
License Number StateMD

VIII. Authorized Official

Name: MRS. LORENA RIPOLL
Title or Position: OWNER
Credential:
Phone: 301-846-7872