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General NPI Number Information
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NPI Number | 1164130928
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Entity Type | Organization
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Legal Business Name | CHANGING LANES, LLC
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 534 N MAIN ST
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City | EMPORIA
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State | VA
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Zip | 23847-1236
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Country | US
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Telephone | 434-632-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 W END DR
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City | EMPORIA
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State | VA
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Zip | 23847-2780
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Country | US
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Telephone | 434-829-6649
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | LIQUITTA ATKINS LEE
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Credential |
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Telephone | 434-829-6649
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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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