Provider Demographics
NPI:1265713705
Name:CHANGING CYCLES, LLC
Entity type:Organization
Organization Name:CHANGING CYCLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT AND COO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYONA
Authorized Official - Middle Name:SHANTRICE
Authorized Official - Last Name:THOMAS-KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MA, LCPC
Authorized Official - Phone:301-357-6605
Mailing Address - Street 1:3475 LEONARDTOWN RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3678
Mailing Address - Country:US
Mailing Address - Phone:301-357-6605
Mailing Address - Fax:
Practice Address - Street 1:14460 OLD MILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3092
Practice Address - Country:US
Practice Address - Phone:301-357-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13986101YP2500X
MDLC2555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD440314200Medicaid