Healthcare Provider Details

I. General information

NPI: 1457458721
Provider Name (Legal Business Name): A CHANGE COUNSELING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 S M ST STE C
TACOMA WA
98418-3800
US

IV. Provider business mailing address

4002 S M ST STE C
TACOMA WA
98418-3800
US

V. Phone/Fax

Practice location:
  • Phone: 253-473-1844
  • Fax: 253-473-1839
Mailing address:
  • Phone: 253-473-1844
  • Fax: 253-473-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCP00000521
License Number StateWA

VIII. Authorized Official

Name: MRS. MELINDA J BROUSSARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 253-473-1844