Organization
DYNAMIC CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUDIA CORBIN (DIRECTOR)
(443) 537-5246
Entity
Organization
Contact information
Practice address
405 LONG ISLAND AVE APT B, BALTIMORE, MD 21229-4010
(443) 537-5246
Mailing address
7651 MANDRAKE CT UNIT 305, ELKRIDGE, MD 21075-7985
(443) 537-5246
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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