Healthcare Provider Details

I. General information

NPI: 1528777158
Provider Name (Legal Business Name): JOURNEY THROUGH CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 PERE MARQUETTE DR STE 3B
LANSING MI
48912-1270
US

IV. Provider business mailing address

1408 BISCAYNE WAY
HASLETT MI
48840-8410
US

V. Phone/Fax

Practice location:
  • Phone: 734-531-7763
  • Fax:
Mailing address:
  • Phone: 517-410-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA MARIE CHARRON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D./L.P.
Phone: 518-410-8512