Provider Demographics
NPI:1366926032
Name:CONVERSATIONS CREATE CHANGE LLC
Entity type:Organization
Organization Name:CONVERSATIONS CREATE CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYEMAN-ANANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-275-6962
Mailing Address - Street 1:574F RITCHIE HWY STE 171
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2925
Mailing Address - Country:US
Mailing Address - Phone:301-275-6962
Mailing Address - Fax:
Practice Address - Street 1:574F RITCHIE HWY STE 171
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2925
Practice Address - Country:US
Practice Address - Phone:301-275-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD743203800Medicaid
MD777307Medicaid