Provider Demographics
NPI:1255879680
Name:CHANGING MINDS/CHANGING LIVES HOME MANAGEMENT & LIFE COACHING CENTER
Entity type:Organization
Organization Name:CHANGING MINDS/CHANGING LIVES HOME MANAGEMENT & LIFE COACHING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/LIFE COACH
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:571-241-6966
Mailing Address - Street 1:6300 EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 EDWARD DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4135
Practice Address - Country:US
Practice Address - Phone:571-241-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service