Healthcare Provider Details

I. General information

NPI: 1487101580
Provider Name (Legal Business Name): CHANGE M.F.C.R
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-5000
US

IV. Provider business mailing address

620 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6834
US

V. Phone/Fax

Practice location:
  • Phone: 407-485-5445
  • Fax: 407-577-2096
Mailing address:
  • Phone: 407-875-5704
  • Fax: 407-577-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CAROLINA ALVAREZ
Title or Position: PRESIDENT
Credential: LMFT
Phone: 407-485-5445