Organization
CREATIVE CHANGE DYNAMIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMONIQUE MALLOY PSY.D (OWNER)
(240) 528-3406
Entity
Organization
Contact information
Practice address
2825 ROBINSON PLACE, SE # 102, WASHINGTON, DC 20020
(240) 528-3406
Mailing address
PO BOX 2003, GREENBELT, MD 20768-2003
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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