| Changing Generational Legacies,llc | |
|
1401 Mercantile Ln Suite 200-q Largo MD 20774-4301 | |
| (301) 322-4141 | |
| (301) 322-9199 |
| Full Name | Changing Generational Legacies,llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1401 Mercantile Ln, Largo, Maryland |
| Authorized Official Name and Position | Debra Joyce Johnson (CEO, FOUNDER) |
| Authorized Official Contact | 3013224141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Generational Legacies,llc 1401 Mercantile Ln Suite 200-q Largo MD 20774-4301 Ph: (301) 322-4141 | Changing Generational Legacies,llc 1401 Mercantile Ln Suite 200-q Largo MD 20774-4301 Ph: (301) 322-4141 |
| NPI Number | 1598012155 |
|---|---|
| Provider Enumeration Date | 08/13/2012 |
| Last Update Date | 08/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598012155 | NPI | - | NPPES |
| 040457800 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC3809 (Maryland) | Primary |
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