Provider Demographics
NPI:1568104008
Name:SEEDS FOR CHANGE LLC
Entity Type:Organization
Organization Name:SEEDS FOR CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONDELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-880-6065
Mailing Address - Street 1:8898 ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-2408
Mailing Address - Country:US
Mailing Address - Phone:443-880-6065
Mailing Address - Fax:
Practice Address - Street 1:1406 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7162
Practice Address - Country:US
Practice Address - Phone:443-880-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty