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General NPI Number Information
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NPI Number | 1043516727
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Entity Type | Organization
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Legal Business Name | CHANGING DYNAMICS-CHANGING LIVES, LLC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 706 W BROOKLAND PARK BLVD
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City | RICHMOND
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State | VA
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Zip | 23222-2515
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Country | US
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Telephone | 540-455-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 706 W BROOKLAND PARK BLVD
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City | RICHMOND
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State | VA
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Zip | 23222-2515
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. CHERYL L SIMMS
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Credential | MA, LPC, CSAC
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Telephone | 540-270-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102319
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 07011004763
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License Number State | VA
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