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General NPI Number Information
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NPI Number | 1225594922
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHANGE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 8109 MECHANICSVILLE TPKE UNIT 2A
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1209
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Country | US
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Telephone | 804-446-4706
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Fax |
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Provider Business Mailing Address
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Address Line | 8109 MECHANICSVILLE TPKE UNIT 2A
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1209
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Country | US
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Telephone | 804-446-4706
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHAINA JENKINS
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Credential | MS, QMHP-A/C
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Telephone | 804-239-9597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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