Provider Demographics
NPI:1306469952
Name:CHANGE BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CHANGE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIMENE
Authorized Official - Middle Name:KISWEY
Authorized Official - Last Name:DIOMI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:240-401-3062
Mailing Address - Street 1:8025 LIGHTHOUSE LNDG
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-9306
Mailing Address - Country:US
Mailing Address - Phone:240-830-1358
Mailing Address - Fax:301-732-7725
Practice Address - Street 1:18310 MONTGOMERY VILLAGE AVE STE 300
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3552
Practice Address - Country:US
Practice Address - Phone:240-830-1358
Practice Address - Fax:301-732-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty