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General NPI Number Information
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NPI Number | 1174373179
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHANGE CENTER: WEAREONE, INCORPORATED
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 4444 CONNECTICUT ST
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City | GARY
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State | IN
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Zip | 46409-2126
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Country | US
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Telephone | 219-885-9560
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Fax |
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Provider Business Mailing Address
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Address Line | 7112 VAN BUREN CT
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3859
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Country | US
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Telephone | 765-430-8952
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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 | SAMANTHA BURGETT
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Credential | LCSW
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Telephone | 765-430-8952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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