Healthcare Provider Details

I. General information

NPI: 1659123610
Provider Name (Legal Business Name): BE THE CHANGE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 GEORGE BISHOP PKWY UNIT C
MYRTLE BEACH SC
29579-7465
US

IV. Provider business mailing address

206 GEORGE BISHOP PKWY UNIT C
MYRTLE BEACH SC
29579-7465
US

V. Phone/Fax

Practice location:
  • Phone: 843-516-6757
  • Fax:
Mailing address:
  • Phone: 843-516-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PAMELA BROWN
Title or Position: PARTNER
Credential: LISW-CP
Phone: 843-516-6757