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General NPI Number Information
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NPI Number | 1114323482
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Entity Type | Organization
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Legal Business Name | RELIANCE4CHANGE
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 999 LINAM AVE SE
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City | ATLANTA
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State | GA
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Zip | 30315-1818
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Country | US
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Telephone | 678-667-0624
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Fax |
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Provider Business Mailing Address
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Address Line | 999 LINAM AVE SE
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City | ATLANTA
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State | GA
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Zip | 30315-1818
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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 | EXECUTIVE DIRECTOR
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Name | MELEAH BROWN
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Credential | LPC CRC
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Telephone | 562-673-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC008083
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License Number State | GA
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