Healthcare Provider Details

I. General information

NPI: 1346103926
Provider Name (Legal Business Name): BRAIN CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 TALISMAN DR
MARTINSBURG WV
25403-2291
US

IV. Provider business mailing address

465 TALISMAN DR
MARTINSBURG WV
25403-2291
US

V. Phone/Fax

Practice location:
  • Phone: 814-283-5264
  • Fax:
Mailing address:
  • Phone: 814-283-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AYLA GRESSLER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 814-777-3476