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General NPI Number Information
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NPI Number | 1700577012
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Entity Type | Organization
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Legal Business Name | LIVING CHANGES LLC
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 686 208TH ST
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City | PASADENA
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State | MD
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Zip | 21122-1424
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Country | US
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Telephone | 301-943-5207
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Fax |
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Provider Business Mailing Address
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Address Line | 7476 BALTIMORE ANNAPOLIS BLVD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3542
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Country | US
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Telephone | 301-943-5207
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | MS. MELISSA SIMKIN-BROCATO
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Credential |
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Telephone | 443-517-8724
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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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