Healthcare Provider Details

I. General information

NPI: 1669319448
Provider Name (Legal Business Name): CHANGES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 BESSIE CLEMSON RD
UNION BRIDGE MD
21791-7519
US

IV. Provider business mailing address

9097 BESSIE CLEMSON RD
UNION BRIDGE MD
21791-7519
US

V. Phone/Fax

Practice location:
  • Phone: 240-308-0343
  • Fax: 240-308-0343
Mailing address:
  • Phone: 240-308-0343
  • Fax: 240-308-0343

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: STACEY SULLIVAN-TESTA
Title or Position: OWNER
Credential: LCPC
Phone: 240-308-0343