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General NPI Number Information
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NPI Number | 1568104008
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Entity Type | Organization
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Legal Business Name | SEEDS FOR CHANGE LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1406 S SALISBURY BLVD
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City | SALISBURY
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State | MD
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Zip | 21801-7162
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Country | US
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Telephone | 443-880-6065
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Fax |
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Provider Business Mailing Address
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Address Line | 8898 ATHOL RD
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City | MARDELA SPRINGS
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State | MD
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Zip | 21837-2408
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Country | US
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Telephone | 443-880-6065
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. SHONDELLE JOHNSON-PUGH
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Credential | LCSWC
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Telephone | 443-880-6065
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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 |
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License Number State |
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