Provider Demographics
NPI:1902329048
Name:A CHANGE WOULD DO YOU GOOD, LLC
Entity Type:Organization
Organization Name:A CHANGE WOULD DO YOU GOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-C, LCADC
Authorized Official - Phone:443-945-9663
Mailing Address - Street 1:296 N SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1311
Mailing Address - Country:US
Mailing Address - Phone:443-945-9663
Mailing Address - Fax:
Practice Address - Street 1:102 E CECIL AVE STE B
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-4057
Practice Address - Country:US
Practice Address - Phone:443-945-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11558261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)