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General NPI Number Information
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NPI Number | 1902329048
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Entity Type | Organization
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Legal Business Name | A CHANGE WOULD DO YOU GOOD, LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 102 E CECIL AVE STE B
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City | NORTH EAST
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State | MD
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Zip | 21901-4057
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Country | US
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Telephone | 443-945-9663
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Fax |
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Provider Business Mailing Address
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Address Line | 296 N SAINT AUGUSTINE RD
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City | CHESAPEAKE CITY
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State | MD
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Zip | 21915-1311
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Country | US
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Telephone | 443-945-9663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTINE MONIQUE HITCHENS
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Credential | PHD, LCSW-C, LCADC
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Telephone | 443-945-9663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 11558
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License Number State | MD
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