Provider Demographics
NPI:1790292126
Name:EMBRACING CHANGE COUNSELING & MENTORING SERVICES, INC.
Entity Type:Organization
Organization Name:EMBRACING CHANGE COUNSELING & MENTORING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-299-5985
Mailing Address - Street 1:3200 CRAIN HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4843
Mailing Address - Country:US
Mailing Address - Phone:240-299-5985
Mailing Address - Fax:
Practice Address - Street 1:3200 CRAIN HWY STE 205
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4843
Practice Address - Country:US
Practice Address - Phone:240-299-5985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD819916Medicaid