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General NPI Number Information
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NPI Number | 1396688271
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Entity Type | Organization
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Legal Business Name | DYNAMIC CHANGE
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Dates
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Enumeration Date | 04/14/2026
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 405 LONG ISLAND AVE APT B
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City | BALTIMORE
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State | MD
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Zip | 21229-4010
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Country | US
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Telephone | 443-537-5246
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Fax |
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Provider Business Mailing Address
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Address Line | 7651 MANDRAKE CT UNIT 305
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City | ELKRIDGE
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State | MD
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Zip | 21075-7985
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Country | US
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Telephone | 443-537-5246
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUDIA CORBIN
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Credential |
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Telephone | 443-537-5246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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