Provider Demographics
NPI:1548846223
Name:REAL LIFE CHANGES, LLC
Entity type:Organization
Organization Name:REAL LIFE CHANGES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:443-685-8565
Mailing Address - Street 1:28 E SUSQUEHANNA AVE STE 101&102
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5218
Mailing Address - Country:US
Mailing Address - Phone:443-685-8565
Mailing Address - Fax:
Practice Address - Street 1:28 E SUSQUEHANNA AVE STE 101&102
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5218
Practice Address - Country:US
Practice Address - Phone:443-685-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health