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General NPI Number Information
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NPI Number | 1245656776
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Entity Type | Organization
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Legal Business Name | CROSSWALK TO CHANGE, LLC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 12676 NATIONAL PIKE
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City | GRANTSVILLE
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State | MD
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Zip | 21536-3320
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Country | US
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Telephone | 301-895-8087
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Fax | 301-895-8097
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Provider Business Mailing Address
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Address Line | 12676 NATIONAL PIKE
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City | GRANTSVILLE
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State | MD
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Zip | 21536-3320
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Country | US
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Telephone | 301-895-8087
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Fax | 301-895-8097
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VICKY LYNN ZANG
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Credential | LCSW-C
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Telephone | 301-895-8087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16149
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License Number State | MD
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