Healthcare Provider Details

I. General information

NPI: 1487148359
Provider Name (Legal Business Name): BE THE CHANGE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BLANTON AVE
RICHMOND VA
23221-3603
US

IV. Provider business mailing address

1605 WHITE CEDAR LN
N CHESTERFLD VA
23235-5449
US

V. Phone/Fax

Practice location:
  • Phone: 804-621-2650
  • Fax: 804-369-9709
Mailing address:
  • Phone: 804-621-2650
  • Fax: 804-369-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004430
License Number StateVA

VIII. Authorized Official

Name: MS. MARY ANNE TAYLOR
Title or Position: OWNER
Credential: LCSW
Phone: 804-621-2650