Healthcare Provider Details

I. General information

NPI: 1336685973
Provider Name (Legal Business Name): CHANGE BY CHOICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 NW 53RD AVE STE B
GAINESVILLE FL
32653-4856
US

IV. Provider business mailing address

4715 NW 53RD AVE STE B
GAINESVILLE FL
32653-4856
US

V. Phone/Fax

Practice location:
  • Phone: 352-575-8344
  • Fax:
Mailing address:
  • Phone: 352-575-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9295
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2959
License Number StateFL

VIII. Authorized Official

Name: MRS. SARAH L ATKINSON
Title or Position: COUNSELOR/ MANAGER
Credential: ED. S, LMFT, LMHC
Phone: 352-575-8344