Change Behavioral Health Services LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) in Gaithersburg, MD. Organization (NPI-2).

NPI number1306469952

StatusActive

Last updated in NPPESMar 18, 2025

Details

NPI: 1306469952
Entity type: Organization (NPI-2)
Legal business name: Change Behavioral Health Services LLC
Organization subpart: No
Enumeration date: May 18, 2020
Certification date: Mar 18, 2025
Last updated: Mar 18, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–	Yes
163WP0808X	Registered Nurse, Psych/Mental Health	–	–
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–

Practice location

18310 Montgomery Village Ave Ste 300
Gaithersburg, MD 20879-3552

Phone 240-830-1358 · Fax 301-732-7725

Mailing address

8025 Lighthouse Lndg
Frederick, MD 21701-9306

Phone 240-830-1358 · Fax 301-732-7725

Authorized official

Chimene Kiswey Diomi
Owner
2404013062

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