Healthcare Provider Details

I. General information

NPI: 1558123703
Provider Name (Legal Business Name): BRAVE CHANGES COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SHADY SUMMIT WAY
RALEIGH NC
27603-4877
US

IV. Provider business mailing address

717 SHADY SUMMIT WAY
RALEIGH NC
27603-4877
US

V. Phone/Fax

Practice location:
  • Phone: 910-644-0414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
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: LAUREN BLUE
Title or Position: OWNER
Credential: LCMHC, CCTP
Phone: 910-644-0414