Healthcare Provider Details

I. General information

NPI: 1538465349
Provider Name (Legal Business Name): COUNSELING FOR CHANGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 LINCOLN AVE
EVANSVILLE IN
47714-1028
US

IV. Provider business mailing address

PO BOX 3117
EVANSVILLE IN
47730-3117
US

V. Phone/Fax

Practice location:
  • Phone: 812-491-2615
  • Fax: 812-471-6650
Mailing address:
  • Phone: 812-491-2615
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBIN MAGLINGER
Title or Position: OWNER
Credential: LCSW
Phone: 812-491-2615