Healthcare Provider Details

I. General information

NPI: 1144830696
Provider Name (Legal Business Name): GUIDED CHANGE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 RITCHIE HWY STE 126
SEVERNA PARK MD
21146-4145
US

IV. Provider business mailing address

815 RITCHIE HWY STE 126
SEVERNA PARK MD
21146-4145
US

V. Phone/Fax

Practice location:
  • Phone: 443-574-5089
  • Fax:
Mailing address:
  • Phone: 443-574-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA ROSE WEEG
Title or Position: OWNER
Credential: LCPC
Phone: 443-574-5089