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General NPI Number Information
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NPI Number | 1265233795
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Entity Type | Organization
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Legal Business Name | BALANCED CHANGE NUTRITION AND WELLNESS
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 12528 BIRCHFALLS DR
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City | RALEIGH
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State | NC
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Zip | 27614-9676
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Country | US
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Telephone | 984-600-0997
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Fax |
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Provider Business Mailing Address
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Address Line | 12528 BIRCHFALLS DR
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City | RALEIGH
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State | NC
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Zip | 27614-9676
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Country | US
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Telephone | 984-600-0997
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | DAMIAN GANOE
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Credential | RDN
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Telephone | 984-600-0997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 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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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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