Healthcare Provider Details

I. General information

NPI: 1801409438
Provider Name (Legal Business Name): CHANGING BY CHOICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 LAKESIDE AVE STE 23
HENRICO VA
23228-5748
US

IV. Provider business mailing address

2510 EDENBROOK DR
HENRICO VA
23228-3038
US

V. Phone/Fax

Practice location:
  • Phone: 804-495-3000
  • Fax: 804-495-3003
Mailing address:
  • Phone: 804-420-5405
  • Fax: 804-495-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARCELIA MILLER-JACKSON
Title or Position: CEO
Credential: MA, MDIV, LPC, LSATP
Phone: 804-495-3000