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General NPI Number Information
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NPI Number | 1093458051
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Entity Type | Organization
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Legal Business Name | CULTIVATING CHANGE
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 2512 N. CHARLES STREET 1ST FLOOR/B
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City | BALTIMORE
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State | MD
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Zip | 21218-4645
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Country | US
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Telephone | 410-493-3372
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 N. CHARLES STREET 1ST FLOOR/B
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City | BALTIMORE
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State | MD
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Zip | 21218-4645
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Country | US
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Telephone | 410-493-3372
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DELORA WALKER
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Credential |
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Telephone | 410-493-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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