Healthcare Provider Details

I. General information

NPI: 1750219051
Provider Name (Legal Business Name): PROACTIVE CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 TWINRIDGE LN
NORTH CHESTERFIELD VA
23235-5268
US

IV. Provider business mailing address

605 TWINRIDGE LN
NORTH CHESTERFIELD VA
23235-5268
US

V. Phone/Fax

Practice location:
  • Phone: 804-909-7395
  • Fax:
Mailing address:
  • Phone: 804-909-7395
  • 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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON HOLLEY
Title or Position: CEO
Credential:
Phone: 804-909-9928