| Change Reaction, Corp | |
|
4404 Queensbury Rd Ste 105 Riverdale MD 20737-1074 | |
| (301) 864-0919 | |
| (301) 864-1301 |
| Full Name | Change Reaction, Corp |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4404 Queensbury Rd Ste 105, Riverdale, Maryland |
| Authorized Official Name and Position | Kimberly M Green (OWNER/PROGRAM MANAGER) |
| Authorized Official Contact | 3014089639 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Reaction, Corp 4404 Queensbury Rd Ste 105 Riverdale MD 20737-1074 Ph: (301) 864-0919 | Change Reaction, Corp 4404 Queensbury Rd Ste 105 Riverdale MD 20737-1074 Ph: (301) 864-0919 |
| NPI Number | 1659754091 |
|---|---|
| Provider Enumeration Date | 07/02/2015 |
| Last Update Date | 12/13/2021 |
| Certification Date | 12/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659754091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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