Healthcare Provider Details

I. General information

NPI: 1316861073
Provider Name (Legal Business Name): CHANGE AND GROW THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 LANCASTER AVE
MALVERN PA
19355-2122
US

IV. Provider business mailing address

1485 GREENLEAF DR N
WARRINGTON PA
18976-1337
US

V. Phone/Fax

Practice location:
  • Phone: 267-629-2071
  • 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

VIII. Authorized Official

Name: ALEXANDRIA KAZANDJIAN
Title or Position: MEMBER
Credential: LPC
Phone: 267-629-2071