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General NPI Number Information
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NPI Number | 1194177675
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Entity Type | Organization
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Legal Business Name | WAVES OF CHANGE, LLC
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 2017 4TH ST
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City | JACKSON
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State | MI
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Zip | 49203-4572
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Country | US
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Telephone | 517-581-4886
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Fax | 517-905-6046
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Provider Business Mailing Address
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Address Line | 7625 KING RD
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City | SPRING ARBOR
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State | MI
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Zip | 49283-9777
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Country | US
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Telephone | 517-581-4886
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Fax | 517-905-6046
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | AMBER JOY NORWOOD
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Credential | LMSW
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Telephone | 517-581-4886
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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 | 6801094168
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License Number State | MI
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