Healthcare Provider Details

I. General information

NPI: 1427985183
Provider Name (Legal Business Name): CHANGING LIVES MENTAL HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 INDIAN RIVER RD
CHESAPEAKE VA
23325-3131
US

IV. Provider business mailing address

4406 INDIAN RIVER RD
CHESAPEAKE VA
23325-3131
US

V. Phone/Fax

Practice location:
  • Phone: 912-247-9567
  • Fax: 804-884-3702
Mailing address:
  • Phone: 912-247-9567
  • Fax: 804-884-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CATRINA ARNICKA BANKS
Title or Position: OWNER
Credential: QMHP
Phone: 912-247-9567