Healthcare Provider Details

I. General information

NPI: 1093301210
Provider Name (Legal Business Name): FOUNDATIONS4CHANGE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 12/13/2020
Certification Date: 12/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 NEW WAVERLY PL STE 210
CARY NC
27518-7405
US

IV. Provider business mailing address

508 ANCIENT OAKS DR
HOLLY SPRINGS NC
27540-4466
US

V. Phone/Fax

Practice location:
  • Phone: 919-324-4120
  • Fax: 919-439-5340
Mailing address:
  • Phone: 919-324-4120
  • Fax: 919-439-5340

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIN MARIE BIRCHER
Title or Position: PSYCHOTHERAPIST
Credential: LCMHC, LCAS
Phone: 919-324-4120