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General NPI Number Information
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NPI Number | 1154700748
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Entity Type | Organization
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Legal Business Name | CHANGE HAPPENS COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 110 CYPRESS RD
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City | BYRAM
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State | MS
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Zip | 39272-6046
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Country | US
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Telephone | 601-316-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CYPRESS RD
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City | BYRAM
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State | MS
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Zip | 39272-6046
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Country | US
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Telephone | 601-316-0951
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TISSAN JACKSON
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Credential |
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Telephone | 601-316-0951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M7339
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License Number State | MS
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