Provider Demographics
NPI:1174927164
Name:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Entity type:Organization
Organization Name:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER-DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:410-254-6714
Mailing Address - Street 1:PO BOX 7036
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-0036
Mailing Address - Country:US
Mailing Address - Phone:410-258-6714
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN ROAD
Practice Address - Street 2:SUITE 25A
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5003
Practice Address - Country:US
Practice Address - Phone:410-258-6714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148791041S0200X, 106H00000X, 1041C0700X
2084A0401X, 208U00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No208U00000XAllopathic & Osteopathic PhysiciansClinical PharmacologyGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty