Organization
CHANGE REACTION
Active
Other names
Change Reaction
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY M GREEN (OWNER/PROGRAM MANAGER)
(301) 864-0919
Entity
Organization
Contact information
Practice address
4404 QUEENSBURY RD STE 105, RIVERDALE, MD 20737-1074
(240) 432-7659
(301) 864-1301
Mailing address
4404 QUEENSBURY RD STE 105, RIVERDALE, MD 20737-1074
(240) 432-7659
(301) 864-1301
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/31/2021
Last updated
08/31/2021
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