Healthcare Provider Details

I. General information

NPI: 1811798218
Provider Name (Legal Business Name): CHANGING COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8917 GRAND HIGHLAND WAY
WAKE FOREST NC
27587-1501
US

IV. Provider business mailing address

PO BOX 690310
CHARLOTTE NC
28227-7005
US

V. Phone/Fax

Practice location:
  • Phone: 919-771-3331
  • Fax:
Mailing address:
  • Phone: 919-771-3331
  • Fax:

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 Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHONDA HUNTLEY
Title or Position: CO OWNER
Credential:
Phone: 919-771-3331