Provider Demographics
NPI:1285277343
Name:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Entity type:Organization
Organization Name:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER-DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-258-6714
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 1:4654 YORK RD # 1A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4726
Practice Address - Country:US
Practice Address - Phone:410-258-6714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-22
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children