Provider Demographics
NPI:1497256820
Name:CHANGE TREATMENT LLC
Entity Type:Organization
Organization Name:CHANGE TREATMENT LLC
Other - Org Name:CHANGE TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WERE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSC
Authorized Official - Phone:410-831-5756
Mailing Address - Street 1:806 ROUNDTOP CT APT 3A
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5041
Mailing Address - Country:US
Mailing Address - Phone:410-831-5756
Mailing Address - Fax:
Practice Address - Street 1:2926 E COLD SPRING LN STE 3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2800
Practice Address - Country:US
Practice Address - Phone:443-650-8494
Practice Address - Fax:888-712-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170382207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty