Healthcare Provider Details

I. General information

NPI: 1730441775
Provider Name (Legal Business Name): LIFE CHANGEZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 LOGOS CT
RALEIGH NC
27610-3481
US

IV. Provider business mailing address

1100 LOGGER CT STE A102
RALEIGH NC
27609-8506
US

V. Phone/Fax

Practice location:
  • Phone: 919-803-7125
  • Fax: 919-803-2808
Mailing address:
  • Phone: 919-803-2799
  • Fax: 919-803-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-092-844
License Number StateNC

VIII. Authorized Official

Name: MISS RENE COFER WHITEHEAD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-538-8920