Provider Demographics
NPI:1073226361
Name:TRANSFORMATION HEALTH, LLC
Entity Type:Organization
Organization Name:TRANSFORMATION HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LANEY
Authorized Official - Last Name:BODDIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-224-3002
Mailing Address - Street 1:4083 DORSEYS RIDGE SQ
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5469
Mailing Address - Country:US
Mailing Address - Phone:443-224-3002
Mailing Address - Fax:
Practice Address - Street 1:2288 BLUE WATER BLVD STE 315&317
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3309
Practice Address - Country:US
Practice Address - Phone:443-759-9592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health