Healthcare Provider Details

I. General information

NPI: 1225731235
Provider Name (Legal Business Name): INSTITUTE FOR BEHAVIORAL CHANGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 303
WALDORF MD
20601-2817
US

IV. Provider business mailing address

2670 CRAIN HWY STE 303
WALDORF MD
20601-2817
US

V. Phone/Fax

Practice location:
  • Phone: 301-818-0092
  • Fax: 301-818-0110
Mailing address:
  • Phone: 301-818-0092
  • Fax: 301-818-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEVONE CLARICE WILLIAMS
Title or Position: COO
Credential:
Phone: 301-818-0092