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General NPI Number Information
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NPI Number | 1124591094
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Entity Type | Organization
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Legal Business Name | CHANGING PLACES THERAPEUTIC CENTER, COMPANY
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 1044 BRAGG BLVD STE B
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4512
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Country | US
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Telephone | 910-273-9956
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 542
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City | HOPE MILLS
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State | NC
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Zip | 28348-0542
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Country | US
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Telephone | 910-273-9956
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | BIANCO HOLMON
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Credential | MSW, LCSWS, LCAS-A
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Telephone | 910-273-9956
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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 |
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License Number State |
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