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General NPI Number Information
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NPI Number | 1932693611
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Entity Type | Organization
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Legal Business Name | AWAY OF CHANGE COUNSELING SERVICE, LLC
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 6609 REISTERSTOWN RD STE 206
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City | BALTIMORE
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State | MD
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Zip | 21215-2315
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Country | US
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Telephone | 443-405-3193
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Fax | 443-272-7572
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Provider Business Mailing Address
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Address Line | 5310 OLD COURT RD STE 304
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-6202
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Country | US
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Telephone | 443-405-3193
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Fax | 443-272-7572
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | MS. DORIS ALLEN
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Credential | MED, M.S., LCADC
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Telephone | 443-405-3193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA2042
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License Number State | MD
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